EC Clinical and Medical Case Reports

We report a case of acute pontine ischemic lesion concomitant with a traumatic vertebral artery dissection (VAD) after cervical fracture. A patient in their 80s was referred to our hospital with a right brachio-crural hemiparesis and dysarthria after multiple low-energy falls without witness and cervical pain from a previous fall two weeks ago. A cervical computed tomography (CT) scan undergone at admission showed a traumatic C2 fracture Anderson Alonzo type 2 without involvement of transverse foramina. A neck angio-CT showed a left vertebral artery dissection at the fracture level which was confirmed by a cervical magnetic resonance imaging (MRI) revealing a loss of signal void on the left vertebral artery at V2-V3 junction. No cervical medullary injury was found. A complementary brain MRI was executed and showed an acute left pontine ischemic lesion and bilateral cerebellar infarction. The patient C2 fracture was treated conservatively by a cervical collar and referred to our stroke unit for the ischemic brain injury management. The purpose of our case report is to attract clinician attention to rare occurrences of pontine infarction in the setting of a traumatic VAD following cervical fracture.

 Keywords: Vertebral Artery Dissection (VAD); Computed Tomography (CT); Magnetic Resonance Imaging (MRI)

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