New Concept of the Development of Brainstem Ischemia in the Setting of Occlusions of the Vertebral Arteries and Radicular and Medullary Arteries in the Presence of the Cervical Spinal Injury

Abstract

Purpose: Investigation of the mechanisms of occlusion of the vertebral arteries, radicular medullary arteries and the formation of ischemic of the brainstem. Methods: We conducted two morphological examinations in the presence of spinal cord trauma in the cervical spine. In the first study we investigated the injured vertebral artery, and in the second study we examined the vertebral artery, spinal cord, basilar artery and brainstem. We conducted a magnetic resonance imaging examination and angiography of the cervical and vertebral arteries in a patient with a dislocation fracture of the cervical region of vertebral column. In the case with a dislocation fracture of the cervical region of vertebral column we conducted a CT and of the injured vertebral arteries, spinal cord and brainstem. A morphological examination indicated the presence of an injury of the vertebral artery wall at the site of the dislocation fracture and arterial thrombosis. Results: The patient with the dislocation fracture of Ði6-Ði7 one vertebral artery was injured, with no evidence of total occlusion. Morphological examination indicated the presence of an injury of the vertebral artery wall at the site of the dislocation fracture and arterial thrombosis. While investigating the vertebral arteries of the patient with the dislocation fracture of Ði5-Ði6, we revealed an endothelial injury and a thrombus formation in the vertebral, radicular and medullary arteries. In the basilar artery a thromboembolic was revealed. While investigating the brainstem, we revealed ischemia and edema of various degrees of severity. Conclusion: Thrombosis and occlusion occurs in the arteries in the setting of the trauma of vertebral arteries in consequence of a dislocation fracture. Thrombosis and thromboembolia can impair the condition of patients and to cause ischemia in the brainstem.