Traumatic lesion of the extracranial vertebral artery a note-worthy potentially lethal injury

The autopsy findings from routine neuropathological investigations of the cervical spine after any history of trauma emphasized the vulnerability of the extracranial vertebral arteries. In 21 cases with trauma to the head and neck, normal autopsy procedures did not succeed in revealing an obvious cause of death. Traumatic lesions of the spinal cord such as contusion or neurorrhexis were seen in 10 cases. In 15 cases we observed different degrees and stages of traumatic lesions of the extracranial vertebral arteries. Sudden death due to acute brain stem ischemia might be considered as an explanation in some of these cases. Six case reports with traumatic vertebral artery (VA) lesions after severe or minor extracranial trauma are presented. A review of the literature revealed that this vascular injury has only rarely been directly established by gross pathological examination. Possible consequences of blunt trauma to the head and neck include angiorrhexis, subintimal, intramural and perivascular hemorrhage leading to a partial narrowing of the injured vessel. These processes can be complicated by thrombosis. Unilateral VA obliteration may be an occult risk of acute brain stem ischemia when associated with contralateral reduction of the posterior circulation.