Concomitant post-traumatic craniocervical junction epidural hematoma and pontomedullary junction infarction - Clinical, neurophysiologic, and neuroradiologic features

Study Design. A case report. Objectives. To report and discuss a case of post-traumatic epidural hematom a of the craniocervical junction with concomitant brain stem infarction. Summary of Background Data. Post-traumatic epidural hematoma of the cervica l spine and brain stem post-traumatic infarction are very rare disorders. P osttraumatic epidural hematoma is usually located dorsally in the epidural space. Methods. The clinical, neuroradiologic, and neurophysiologic findings in on e patient with post-traumatic epidural hematoma located ventrally at the ce rvicomedullary junction and associated with medial infarction at the pontom edullary junction are reported. Results. The main clinical finding in this patient was bilateral corticospi nal and corticobulbar tract involvement A magnetic resonance image showed d isplacement and flattening of the medulla oblongata and of the most cranial portion of cervical cord, which were caused by the epidural hematoma assoc iated with an ischemic lesion of the pontomedullary junction. Results of ce ntral motor conduction studies indicated that the abnormality of the centra l motor pathways was localized at brain stem level, and that there was norm al conduction from the cervicomedullary junction to spinal cord. Conclusion. This is the first reported case of spinal epidural hematoma loc ated ventrally in the cervical spine at the cervicomedullary junction level and concomitant infarction at the pontomedullary junction resulting from w hiplash injury.