A 29-year-old man lost consciousness briefly after falling from a height. Initial examination revealed complete quadriplegia, with normal strength in trapezius and at the C5 sensory level. Cranial nerves were intact. Cervical spine X-ray demonstrated a fracture dislocation of C4, and he underwent C4-5 posterior wiring and fusion. Postoperatively he became unresponsive and two days later, experienced locked-in syndrome. Vertebral angiography demonstrated complete occlusion of the right vertebral artery 2cm proximal to the fracture site, and the mid one-third portion of basilar artery was completely obstructed. We concluded that the thrombus of the vertebral artery caused the thromboembolism of the basilar artery and pontine-infarction during surgery.
