Subintimal dissection of the vertebral artery in subluxation of the cervical spine

The vertebral arteries appear to be particularly susceptible to injury in trauma of the cervical spine because of their close anatomical relationship to the spine; however, traumatic subintimal dissection of the vertebral artery is rare judging from the paucity of cases reported in the literature. The case of a patient who developed a visual field defect secondary to a fracture-subluxation of the cervical spine is reported. Angiography demonstrated an intimal dissection of the vertebral artery at the site of the fracture-subluxation resulting in thrombus formation and subsequently in emboli occluding the posterior temporal branch of the posterior cerebral artery. Early angiography is recommended if extracranial injury of the vertebral artery is suspected, and the institution of heparin therapy is necessary if a subintimal dissection is demonstrated.