PDF(Pubmed)
Abstract：
BACKGROUND: Vertebral artery injury is a rare condition in trauma settings. In the advanced stages, it causes death.
METHODS: A 31-year-old Sundanese woman with cerebral edema, C2-C3 anterolisthesis, and Le Fort III fracture after a motorcycle accident was admitted to the emergency room. On the fifth day, she underwent arch bar maxillomandibular application and debridement in general anesthesia with a hyperextended neck position. Unfortunately, her rigid neck collar was removed in the high care unit before surgery. Her condition deteriorated 72 hours after surgery. Digital subtraction angiography revealed a grade 5 bilateral vertebral artery injury due to cervical spine displacement and a grade 4 left internal carotid artery injury with a carotid cavernous fistula (CCF). The patient was declared brain death as not improved cerebral perfusion after CCF coiling.
CONCLUSIONS: Brain death due to cerebral hypoperfusion following cerebrovascular injury in this patient could be prevented by early endovascular intervention and cervical immobilisation.
METHODS: A 31-year-old Sundanese woman with cerebral edema, C2-C3 anterolisthesis, and Le Fort III fracture after a motorcycle accident was admitted to the emergency room. On the fifth day, she underwent arch bar maxillomandibular application and debridement in general anesthesia with a hyperextended neck position. Unfortunately, her rigid neck collar was removed in the high care unit before surgery. Her condition deteriorated 72 hours after surgery. Digital subtraction angiography revealed a grade 5 bilateral vertebral artery injury due to cervical spine displacement and a grade 4 left internal carotid artery injury with a carotid cavernous fistula (CCF). The patient was declared brain death as not improved cerebral perfusion after CCF coiling.
CONCLUSIONS: Brain death due to cerebral hypoperfusion following cerebrovascular injury in this patient could be prevented by early endovascular intervention and cervical immobilisation.
摘要：
背景：椎动脉损伤在创伤环境中是一种罕见的疾病。在高级阶段，它会导致死亡。
方法：一名31岁的孙丹妇女患有脑水肿，C2-C3前旋，摩托车事故后的LeFortIII骨折被送往急诊室。第五天，她在全身麻醉中接受了上颌下颌弓弓的应用和清创术，颈部位置过度伸展。不幸的是,手术前，她的僵硬颈圈在高监护病房被移除。手术后72小时，她的病情恶化。数字减影血管造影显示，由于颈椎移位，双侧椎动脉损伤为5级，左颈内动脉损伤为4级，伴有颈动脉海绵窦瘘（CCF）。CCF盘绕后脑灌注未改善，患者被宣布脑死亡。
结论：该患者脑血管损伤后脑灌注不足导致的脑死亡可以通过早期血管内介入和宫颈固定来预防。
方法：一名31岁的孙丹妇女患有脑水肿，C2-C3前旋，摩托车事故后的LeFortIII骨折被送往急诊室。第五天，她在全身麻醉中接受了上颌下颌弓弓的应用和清创术，颈部位置过度伸展。不幸的是,手术前，她的僵硬颈圈在高监护病房被移除。手术后72小时，她的病情恶化。数字减影血管造影显示，由于颈椎移位，双侧椎动脉损伤为5级，左颈内动脉损伤为4级，伴有颈动脉海绵窦瘘（CCF）。CCF盘绕后脑灌注未改善，患者被宣布脑死亡。
结论：该患者脑血管损伤后脑灌注不足导致的脑死亡可以通过早期血管内介入和宫颈固定来预防。
