A SIMPLE METHOD FOR DIAGNOSING TRAUMATIC OCCLUSION OF THE VERTEBRAL ARTERY AT THE CRANIOVERTEBRAL JUNCTION

Study Design. A simple method, thin-slice contrast-enhanced computed t omographic (CT) scan, was evaluated as a first-line rapid screening pr ocedure for diagnosing traumatic occlusion of the vertebral artery at the craniovertebral junction. Objectives. This procedure was performed in patients suffering from injuries of the high cervical spine or the craniovertebral junction. Vertebral angiography was undertaken after this procedure to confirm the diagnosis. Summary of Background Data. W ell-enhanced vertebral arteries can be demonstrated clearly in normal subjects by using this method. Occlusion of the vertebral artery produ ces delayed contrast enhancement of the proximal artery and abrupt int erruption of its course. Methods. Thin-slice CT scan was performed fro m the atlas to the occipital condyles after an intravenous injection o f angiograffin. The plane of the CT scan was aligned in a parallel man ner to the upper margin of the atlas. The CT scanning was repeated unt il the contrast enhancement of the vertebral arteries became faint. Re sults. Occlusion of the unilateral vertebral artery was successfully d iagnosed in a patient with Jefferson's fracture by using the present t echnique. A subsequent vertebral angiography confirmed the diagnosis. Conclusions. The present technique should be performed as a routine sc reening procedure in patients suffering from injuries to the craniover tebral junction.