Vertebral Artery Injury

Excerpt

Injuries to the vertebral artery may either be traumatic or spontaneous. Traumatic injuries are most frequently due to blunt injury to the head and neck but may be due to penetrating trauma. Spontaneous injuries are caused by intrinsic weakness of the vessel wall, often due to underlying vascular or connective tissue disorder, leading to dissection of the vessel. Spontaneous dissections are frequently associated with minor precipitating events. A grade of injury can range from an irregularity of the vessel wall to complete transection with intracranial or extracranial hemorrhage. Patients commonly initially present with a headache and neck pain but may be asymptomatic. Vertebral artery injury is an important cause of stroke and transient ischemic attack, particularly in younger patients. The vertebral arteries perfuse the posterior fossa so the patient will present with stroke symptoms consistent with posterior circulation deficits. Symptoms may include difficulty speaking, swallowing, or maintaining their balance. Loss of coordination or vision changes may also be present. The modified Denver screening criteria are used to identify patients at high risk for cerebrovascular injury. The initial diagnostic imaging study of choice is a CT angiogram. Treatment depends on location, symptoms, and degree of injury and may involve fibrinolysis, anticoagulation, antiplatelet therapy, endovascular therapy, or open surgical repair.