Ulus Travma Acil Cerrahi Derg. 2021; 27(6): 697-701 | DOI: 10.14744/tjtes.2020.63679

Ankilozan Spondilit olgusunda travmatik servikal komplet ayrýþma kýrýðý sonrasý iki taraflý vertebral arter oklüzyonu

Berk Benek, Hakan Yilmaz, Emrah Akçay, Alaattin Yurt
Saðlýk Bilimleri Üniversitesi, Bozyaka Eðitim ve Araþtýrma Hastanesi, Beyin ve Sinir Cerrahisi Kliniði, Ýzmir

Ýki taraflý vertebral arter oklüzyonu yüksek enerjili travmalar sonrasý görülebilen nadir ve ölümcül bir yaralanmadýr. Ankilozan spondilit hastasýnda, travma sonrasý komplet spinal kord hasarý ile birlikte servikal ayrýþma kýrýðýný takiben iki taraflý vertebral arter oklüzyonu geliþen ilginç bir olgu sunuldu. Kýrk dokuz yaþýnda erkek hasta trafik kazasý sonrasý acil servise getirildi. ASIA Skalasý Komplet A olarak deðerlendirildi. Servikal bilgisayarlý tomografide (BT) C2 ve C3 seviyesinde komplet ayrýþma kýrýðý saptandý. Manyetik rezonans görüntülemede spinal kordda belirgin basý ve incelme görüldü. BT anjiyografi sonrasý iki taraflý vertebral arter oklüzyonu tespit edildi. Hastanýn nörolojik durumu, bölgede aþýrý kanama ve ödem nedeniyle cerrahi giriþim planlanamadý. Hasta iki gün sonra kaybedildi. Literatürde günümüze kadar bildirilen sadece 13 servikal spinal travma sonrasý iki taraflý vertebral arter oklüzyonu olgusu mevcuttur. Morbidite ve mortalite ile birlikte kötü prognoza neden olabilecek vertebrobaziler iskemi görülebilir. Tanýda altýn standart katater anjiyografi olsa da BT anjiyografinin de yakýn duyarlýlýk ve özgüllüðü vardýr. Vertebral arter oklüzyonu tedavi stratejileri hala netlik kazanmamýþtýr.

Anahtar Kelimeler: Ankilozan spondilit, iki taraflý vertebral arter oklüzyonu, servikal ayrýþma kýrýðý; travma; vertebral arter anjiyografisi.

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Bilateral vertebral artery occlusion after traumatic complete disruption of the cervical spine associated with ankylosing spondylitis

Berk Benek, Hakan Yilmaz, Emrah Akçay, Alaattin Yurt
Department of Neurosurgery, University of Health Sciences Bozyaka Training and Research Hospital, Ýzmir-Turkey

Background: Bilateral vertebral artery occlusion is an uncommon and mortal injury that could be seen after high-energy traumas. We illustrate an extreme case of bilateral vertebral artery occlusion following traumatic cervical disruption with complete spinal cord injury in a patient with ankylosing spondylitis. A 49-year-old male was admitted to our emergency department after a motor vehicle accident. The American Spinal Injury Association Impairment Scale was a complete A grade. Computed tomography (CT) scan of the cervical region revealed complete disruption between C2 and C3 levels. Magnetic resonance imaging showed apparent compression and narrow calibration of the spinal cord. CT angiography demonstrated occlusion of the bilateral vertebral arteries. Because of the neurological status of the patient, extensive hematoma, and edema at the region, no surgical intervention could be planned. The patient died on the second day of his hospitalization. Only fourteen cases of bilateral vertebral artery occlusion following blunt cervical spine traumas have been reported to date. They have a possibility to cause vertebrobasilar ischemic events with a poor prognosis of morbidity and mortality. The gold standard of diagnosis is the catheter angiography, but also CT angiography has close sensitivity and specificity. The treatment strategies of vertebral artery occlusion are still unclear.

Keywords: Ankylosing spondylitis, bilateral vertebral artery occlusion, disruption of cervical spine; trauma; vertebral artery angiography.

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