Vertebral Artery Injury in Blunt Neck Trauma

Aka: Vertebral Artery Injury in Blunt Neck Trauma

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II. Epidemiology

  1. Incidence may be as high as 22% of blunt neck injuries (70% when C-Spine Fracture is present)

III. Risk Factors

  1. Head Trauma
  2. Cervical Spine Trauma
  3. Blunt Neck Trauma

IV. Mechanism

  1. Vertebral Fracture (especially C1-C3)
  2. Neck rotation or distraction
  3. Neck hyperflexion or hyperextension
  4. Facet dislocation
  5. Foramen transversarium Trauma

V. Symptoms

  1. Asymptomatic initially in many cases (despite occult life threatening injury)
  2. Posterior Circulation symptoms
    1. Dysarthria
    2. Ataxia or impaired balance or coordination
    3. Visual Field Defect
    4. Horner Syndrome
    5. Altered Level of Consciousness

VI. Differential Diagnosis

  1. See Carotid Artery Injury in Blunt Neck Trauma

VII. Imaging

  1. CT Angiogram Neck Indications
    1. See Denver Screening Criteria for Blunt Cerebrovascular Injury

VIII. Management

  1. Vascular Surgery Consultation if suspected vascular injury

IX. References

  1. Kalsi, Kaufman and Hudson (2018) Crit Dec Emerg Med 32(10): 3-10

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