Post-traumatic vertebral dissection: MRI results

Abstract

Mr. D.L., aged 43, presented with cervical trauma resulting from a public road accident. Clinical examination revealed tetraparesis unexplained by the CT scan data showing vertebral fractures extending into the right C5 and C6 transverse foramen. Second-line cervical MRI showed edematous medullary contusion associated with occlusion of all the right extracranial VA and with intramural hematoma suggesting underlying vertebral dissection. Its asymptomatic features are related to permeable left AV with functional circle of Willis ensuring the substitution of the vertebro-basilar system. Total occlusion allows to avoid any thrombo-embolic complication. Extracranial VAs dissection is associated with high energy traumas and is related to the severity of the osteo-medullary lesion. In the acute phase, clinical manifestations are masked by other traumatic lesions and symptoms have a delayed onset. The latters are ischemic symptoms resulting from hemodynamic or thrombo-embolic mechanism. Extension of intracranial dissection may cause meningeal haemorrhage. The treatment is based on anticoagulants or antiaggregants in the absence of severe visceral or intracranial lesions. Endovascular treatment is necessary in the presence of an ischemic dynamic threat.