Indication of imaging to identify cerebral infarction due to vertebral artery damage associated with blunt cervical spine injury

Abstract

Introduction: Vertebral artery injury (VAI) due to blunt cervical spine injury (BCSI) can cause severe cerebral infarction. This study aimed to evaluate the risks of cerebral infarction and to develop a brain screening algorithm in patients with BCSI. Methods: We examined the characteristics of 37 consecutive patients diagnosed with BCSI at our institute between January 2017 and April 2021 and retrospectively analyzed the risk factors for post-trauma cerebral infarction, such as patient background characteristics, fracture side and level, vertebral artery (VA) status, details of treatment, and complications. Results: A total of 12 patients (32.4%) had VAI, of whom six were treated with intravascular coil embolization to prevent cerebral infarction after cervical spine surgery. Of the five patients (13.5%) with cerebral infarction, four had VAI and one had intact VAs but with a fracture of the intervertebral foramen on the dominant side of the VA (illustrative case). Only the presence of VAI showed a significant difference in the risk of cerebral infarction onset (p = 0.015). Coil embolization did not increase the risk of postoperative cerebral infarction (p = 0.12). Conclusion: VAI was the only risk factor for the development of cerebral infarction in patients with BCSI, suggesting that head magnetic resonance imaging (MRI) screening is recommended for those with VAI. In patients without VAI, vertebral fractures on the dominant side of the VA might be a risk for cerebral infarction, indicating that head MRI screening should also be considered in these patients.

Keywords

• Blunt cervical spine injury
• Vertebral artery injury
• Cerebral infarction
• Vertebral artery dominancy