Traumatic embolization of vertebral artery
Introduction
Introduction to vertebral artery traumatic embolism Traumatic embolismof vertebralartery is a serious complication of neck contusion. Due to the change of cervical vertebrae, the vertebral artery is distorted, paralyzed and compressed, and transient symptoms appear. Secondary thrombosis can also result from intense traction or tearing of the vertebral artery. The vertebral artery is one of the main blood supply arteries of the brain tissue, and a series of neurological symptoms often appear after embolization. Head traction, braking and anticoagulation measures must be taken in a timely manner. basic knowledge Sickness ratio: 0.0001% Susceptible people: no specific population Mode of infection: non-infectious Complications: ataxia vertebral artery traumatic embolism
Cause
Causes of vertebral artery traumatic embolism
(1) Causes of the disease
Many traumas of the head and neck can lead to traumatic embolism of the vertebral artery, such as neck contusion, cervical vertebrae fracture and dislocation, cervical vertebrae due to ligament rupture and dislocation to compress the vertebral artery, etc., head and neck due to external force excessively recline or rotate, can also damage the vertebra When the arteries and cervical vertebrae are rectified, the vertebral artery is also damaged.
(two) pathogenesis
The site of traumatic embolization of the vertebral artery is different, and the damage is also different.
1. When the vertebral artery of the cervical vertebrae is separated from the innominate artery, it enters the cervical vertebrae above the sixth cervical vertebrae and rises vertically. It is closely related to the cervical vertebrae. When the cervical vertebrae fracture is dislocated, the vertebral artery is easily twisted and pressed. Embolism occurs, the vessel wall is damaged or the intima of the blood vessel is torn, thereby forming a thrombus, which progresses retrogradely.
2. The vertebral artery of the atlantoaxial joint of the atlantoaxial joint leaves the transverse process of the cervical vertebrae at the atlantoaxial joint, and turns from vertical to horizontal. It is close to the posterior arch of the atlas and moves forward. When there is a congenital odontoid, it is not connected. Or in the pathological condition of neck infection, cervical decalcification, and neck ligament relaxation, atlantoaxial dislocation is prone to occur in neck contusion, occipital condyle slips forward, vertebral artery can be compressed and occlusion is caused, and vertebral artery is The atlanto-axial and atlantoaxial joints are directly wrapped by the inferior oblique and transverse interspinous muscles. When the head injury is severely rotated, the vertebral artery can be pressed by any muscle.
3. Vertebral artery occipital large hole vertebral artery in the occipital hole, through the tough occipital occipital membrane and dura mater into the skull, the head over-reverse, the two membranes can compress the vertebral artery.
The internal carotid artery and the vertebral artery are the main sources of cerebral arteries. The branches of the two arteries are mutually anastomosed to form the cerebral artery ring, also known as the Willis ring.
In normal people, the bilateral vertebral arteries have a collateral circulation through the posterior communicating artery (the internal carotid artery branch) (Fig. 1). When one vertebral artery is compressed or embolized, blood supply can be obtained from the other vertebral artery. If there is arteriosclerosis or cervical vertebra hyperplasia and compression of blood vessels, the compensatory function of the above collateral circulation is affected, and vertebral artery occlusion symptoms are prone to occur after contusion, if there is vascular malformation or heavier arteriosclerosis, or only one side of the vertebra Arterial supply of basilar artery blood flow, contusion of vertebral artery is prone to the lack of blood supply of Willis ring, the normal bilateral vertebral artery is more than 70%, if the thicker side of the vertebral artery is embolized, prone to symptoms, in addition, If the cervical vertebrae have been pressed into the vertebral artery, the basilar artery has thrombosis, or there is severe atherosclerotic lesion, the head is excessively rotated to one side when injured, enough to cause the basilar artery blood flow to be interrupted and cause sudden death.
Prevention
Vertebral artery traumatic embolism prevention
1. Head traction cervical dislocation combined with vertebral artery contusion, head traction should be performed immediately, that is, before vertebral artery thrombosis. The effect of traction therapy is greatly affected by the formation of a thrombus after vertebral artery contusion.
2. If the neck brake is not towed, the head and neck activities should be strictly limited.
3. If necessary, anticoagulant drugs may be applied as appropriate to inhibit thrombus expansion.
Complication
Vertebral artery traumatic embolism complications Complications, ataxia, vertebral artery traumatic embolism
Easy vertebral artery thrombosis.
Symptom
Vertebral artery traumatic embolism symptoms common symptoms ataxia brainstem lesion facial numbness spinal cord ischemia dysfunction disorder coma
The traumatic ischemic symptoms of the vertebral artery may be transient or progressive. The vertebral artery may be distorted due to changes in the position of the cervical vertebra, sputum, compression, transient symptoms, and the ischemic symptoms may disappear if the compression factor is removed. The vertebral artery is strongly pulled or torn, which can cause secondary thrombosis and can extend upward to the basilar artery. The ischemic symptoms can develop in a few hours to several days after compression, and develop progressively.
The main branch of the vertebral artery after entering the cranium is the posterior inferior cerebellar artery and the anterior spinal artery. Then the bilateral vertebral artery is synthesized into the basilar artery. Therefore, the main clinical manifestations are brain stem, cerebellum and cervical spinal cord ischemia, ie, the posterior inferior cerebellar artery. Symptoms of the syndrome and brainstem lesions, manifested as dizziness, ataxia, difficulty swallowing, facial numbness, nerves and tongue palsy, basilar artery embolism can occur with ocular dyskinesia, facial paralysis, hemiplegia, quadriplegia and coma, etc. Arterial embolism syndrome is mainly quadriplegia. The upper limb is heavier than the lower limb, accompanied by mild sensory disturbance. The recovery process of quadriplegia is the first lower limb and the upper upper limb. The function recovery of the hand is often slow.
Examine
Examination of vertebral artery traumatic embolism
1. X-ray cervical radiograph can show cervical dislocation, etc., but X-ray film without abnormality can not rule out cervical dislocation and vertebral artery injury.
2. Bilateral vertebral angiography is the most reliable diagnostic method. Due to the influence of collateral circulation and compensatory function, the degree of vertebral artery embolization may not be commensurate with the clinical manifestations. Bilateral vertebral angiography is helpful to fully understand the condition. .
Diagnosis
Diagnosis and diagnosis of vertebral artery traumatic embolism
Diagnostic criteria
1. History has a history of recent neck contusion or external force on the neck.
2. Clinical manifestations With or without cervical spine fracture or dislocation, as long as there is brain stem ischemia or cervical spinal cord ischemia symptoms, and neurological examination shows cerebellar and brain stem lesions, it should be highly alert to vertebral artery injury.
3. Auxiliary examination and diagnosis.
Differential diagnosis
1. Acute brain injury The symptoms of encephalopathy generally appear earlier. The diagnosis can be established from the history of trauma and the signs of head trauma. The posterior inferior cerebellar artery syndrome and brain stem symptoms of vertebral artery injury are generally slow, from injury to acute vertebral artery. Sudden blood supply causes sudden death, often with an intermediate waking period.
2. Acute traumatic cervical spinal cord quadriplegia occurs rapidly, with severe degree, long-stem symptoms of the spinal cord are obvious, and the recovery process of the symptoms is also very slow. The quadriplegia is caused by vertebral artery embolism, and the upper limb is heavier than the lower limb, accompanied by slight or no long-sense sensation. Symptoms, the recovery process is faster, but if the cervical spinal cord ischemia time is too long after injury, the spinal cord damage is heavier and irreversible.
