A lateral mass fracture of C1 associated with left vertebral artery and mid-basilar artery occlusion

Extreme acceleration and deceleration forces as well as axial loading are e xerted at the occipito-cervical junction of drivers involved in high-veloci ty motor vehicle accidents, especially with fastened seatbelts. Injury at t his level, usually lethal, can go unrecognized despite modern emergency man agement of the unconscious patient. A precise neurologic and radiographic w orkup of damage to this area is often not possible or overlooked in the ini tial phase of such severe trauma. We describe a patient with multiple injur ies who sustained a left vertebral artery occlusion associated with a left- sided lateral mass fracture of C1 and a basilar artery occlusion resulting in a locked-in syndrome after an automobile accident.