Bilateral vertebral artery injury leads to brain death following traumatic brain injury: a case report

• Published in: Journal of medical case reports Vol. 18; no. 1; p. 106
• Main Authors: Irawany, Vera, Nasution, Vizzi A F, Amalia, Noorcahya
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 16.03.2024; BioMed Central; BMC
• Subjects: Anticoagulants; Asymptomatic; Brain; Brain death; Carotid arteries; Carotid artery injury; Case reports; Cerebrovascular trauma; Cervical vertebrae; Consciousness; Debridement; Digital subtraction angiography; Emergency medical services; Fistula; Glasgow Coma Scale; Injuries; Intensive care; Medical imaging; Neck; Spinal manipulation; Spondylolisthesis; Surgery; Tomography; Trauma; Traumatic brain injury; Veins & arteries; Vertebrae; Digital subtraction angiography; Spondylolisthesis; Cerebrovascular trauma; Carotid artery injury; Cervical vertebrae
• ISSN: 1752-1947; 1752-1947
• DOI: 10.1186/s13256-024-04432-3

Vertebral artery injury is a rare condition in trauma settings. In the advanced stages, it causes death. A 31-year-old Sundanese woman with cerebral edema, C2-C3 anterolisthesis, and Le Fort III fracture after a motorcycle accident was admitted to the emergency room. On the fifth day, she underwent arch bar maxillomandibular application and debridement in general anesthesia with a hyperextended neck position. Unfortunately, her rigid neck collar was removed in the high care unit before surgery. Her condition deteriorated 72 hours after surgery. Digital subtraction angiography revealed a grade 5 bilateral vertebral artery injury due to cervical spine displacement and a grade 4 left internal carotid artery injury with a carotid cavernous fistula (CCF). The patient was declared brain death as not improved cerebral perfusion after CCF coiling. Brain death due to cerebral hypoperfusion following cerebrovascular injury in this patient could be prevented by early endovascular intervention and cervical immobilisation.