Clinically unidentified dissection of vertebral artery as a cause of cerebellar infarction

Background and Purpose-Dissection of vertebral arteries has been reported i n association with minor neck movements without signs of trauma on the surf ace of the neck. In addition, injury of a vertebral artery can cause brain infarctions. However, few cases have been reported in which fatal brain inf arction was due to nonocclusive, clinically undetected, traumatic thrombus formation in a vertebral artery. Case Description-A 62-year-old man was hit by a car, and a right cerebellar infarction was found the day after the accident. The cause of the infarcti on could not be detected by angiography. Although the patient recovered fav orably after surgical removal of the right lateral hemisphere of the cerebe llum, he died suddenly 2 weeks after the accident. An autopsy and a microsc opic study revealed pulmonary thromboembolism and organizing traumatic lesi ons of the right vertebral artery without occlusion or noteworthy stenosis of the artery. Conclusions-We concluded that the patient sustained traumatic lesions of th e right vertebral artery during the traffic accident 2 weeks before death a nd that his cerebellar infarction was due to a thrombus resulting from thes e traumatic lesions.