PMC3658250_01
Axial noncontrast head CT demonstrated hyperdense material within superior sagittal sinus.. Abbreviation: CT, computed tomography.
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Seven hours later, a subarachnoid hemorrhage was detected following computed tomography scans (Figure 1), and repeat lumbar puncture showed xanthochromia.
(A) T2-STIR image demonstrates hyperintensity in left vertebral artery consistent with slowly flowing blood or occlusion (arrow) and hyperintense lesion in spinal cord (arrow head). (B) Axial T2 image showing hyperintense lesion involving bilateral medial medulla (arrow). (C) Sagittal T2-weighted image showing atlantoaxial subluxation, fractured C2 odontoid process (arrow) and hyperintense lesion extending from medulla to C5 (arrowheads).
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T2-short tau inversion recovery images showed disappearance of flow in the left vertebral artery and a hyperintense lesion in the spinal cord (Figure 2A). Axial T2 imaging revealed the hyperintense lesion involving the medial medulla bilaterally, and sagittal T2-weighted images revealed atlantoaxial subluxation, a fractured C2 odontoid process, and a hyperintense lesion extending from the medulla to C5 (Figure 2B and C).
Anteroposterior vertebral arteriograms showing the left vertebral artery occludes and contrast flowstops within the cervical vertebral artery.
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Digital subtraction angiography showed that the left vertebral artery terminated just below the level of vertebral body C2 (Figure 3).