title: Cerebellar infarction resulting from vertebral artery occlusion associated with a Jefferson fracture.
abstract: Neurologic deficit secondary to a Jefferson fracture is rare, as the fracture fragments tend to spread outward. To the authors' knowledge, only five cases of vertebral artery injury associated with C1 fracture have been reported. A 75-year-old man with diffuse spinal hyperostosis hit the top of his head and sustained a Jefferson fracture. The patient presented with vertigo and slurred speech. Magnetic resonance (MR) imaging demonstrated cerebellar infarction, and MR angiography (MRA) showed bilateral vertebral artery occlusion associated with a Jefferson fracture. The patient was placed in a halo vest for a total of 11 weeks and treated with anticoagulant therapy. Vertigo gradually improved, and the patient was able to walk with a cane. Previously slurred speech was completely resolved. This case demonstrates that a Jefferson fracture can cause vertebral artery occlusion, resulting in cerebellar infarction. The clinician should be aware of the possibility and implications of vertebral artery injuries, especially if a fracture involving the foramen transversarium with displacement is documented or if there is a neurologic deficit above the level of injury. Advances in noninvasive imaging such as MRA will facilitate accurate evaluation of these potentially life-threatening vascular injuries.
authors.affiliation: Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Muratsu
authors.forename: Minoru
authors.initials: M
authors.lastname: Doita
authors.forename: Toshihide
authors.initials: T
authors.lastname: Yanagi
authors.forename: Kenji
authors.initials: K
authors.lastname: Sekiguchi
authors.forename: Kotaro
authors.initials: K
authors.lastname: Nishida
authors.forename: Masao
authors.initials: M
authors.lastname: Tomioka
authors.forename: Masahiro
authors.initials: M
authors.lastname: Kurosaka
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D001157:Arterial Occlusive Diseases / Q000175:diagnosis / Q000209:etiology*; D001915:Braces; D002526:Cerebellar Diseases / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D002544:Cerebral Infarction / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology*; D002574:Cervical Vertebrae / Q000293:injuries*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D016103:Spinal Fractures / Q000150:complications* / Q000000981:diagnostic imaging / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014711:Vertebral Artery
chemical_list: D000925:Anticoagulants