PMC6104585_01
CTA cervical spine. Sagittal (a) and Coronal (b) views of right vertebral artery demonstrating lack of visualization of mid-cervical segment at C4-C5 levels. Sagittal (c) and Coronal (d) views of left vertebral artery demonstrating lack of visualization beyond the origin, as well as at C2-C4 and a small segment at C1-C2 level. Prominent vasospasm versus dissection. Fracture dislocation with distraction at C5-C6.
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CT angiogram of the head and neck revealed significant C5-C6 dissociation as well as bilateral vertebral artery injury and large prevertebral hematoma (Fig. 1).
CT cervical spine without contrast, sagittal (a) and coronal (b) views. Avulsion fracture off the anterior, inferior endplate of C5 with disc space widening, consistent with anterior longitudinal ligament injury. Significant retropharyngeal soft tissue swelling.
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MRI and CT of cervical spine re-demonstrated complete dissociation at C5-C6 with bilateral vertebral artery transections and large prevertebral hematoma, as well as spinal cord contusion extending from C2-C7, with significant stenosis (Fig. 2).