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Significance of Magnetic Resonance Imaging in the Diagnosis of Vertebral Artery Injury Associated with Blunt Cervical Spine Trauma

Hiroyuki Yokota, Takahiro Atsumi, Takashi Araki, Akira Fuse, Hidetaka Sato, Makoto Kawai and Yasuhiro Yamamoto

Department of Emergency and Critical Care Medicine, Graduate School of Medicine, Nippon Medical School

Vertebral artery injury associated with non-penetrating cervical trauma is rare. We report 11 cases of vertebral artery injury diagnosed with magnetic resonance imaging (MRI) after blunt trauma to the cervical spine and discuss about the importance of MRI in the diagnosis of this injury. Seven cases were caused by motor vehicle accidents, three by diving accidents, and one by static compression of the neck. All of the patients had documented cervical spine fractures and dislocations. In three patients, the diagnosis of complete occlusion of the vertebral artery was made on the basis of MRI and digital subtraction angiography (DSA). In the other patients, mural injuries of the vertebral artery were demonstrated with DSA. These 11 patients presented with acute, nonspecific changes in neurological status. Two had infarctions of the cerebellum and brainstem. None were treated with anticoagulants. All of them survived and were discharged to other hospitals for physical and occupational therapy. Although DSA remains the gold standard for diagnosing vertebral artery injuries, MRI is a newer modality for assessing cervical cord injury, and it may be useful for evaluating the presence of vertebral injury after blunt cervical spine trauma.

J Nippon Med Sch 2007; 74: 293-299

Keywords
vertebral artery injury, blunt cervical spine trauma, magnetic resonance imaging

Correspondence to
Hiroyuki Yokota, MD, Department of Emergency and Critical Care Medicine, Nippon Medical School Hospital, 1-1-5 Sendagi Bunkyo-ku, Tokyo 113-8603, Japan
yokota@nms.ac.jp

Received, May 2, 2007
Accepted, June 11, 2007