Dissection of the vertebral artery complicating Jefferson fracture

Although traumatic vertebral artery dissections are commonly observed, the association with an upper cervical spine is very rare judging from the scarcity of cases reported in the literature. This report describes the case of a patient with a Jefferson fracture causing a delayed vertebral artery dissection. CT brain scan and magnetic resonance angiography showed an infarction of the cerebellum and brainstem. The patient required a shunt, was treated by a halo orthosis and was anti-coagulated with heparin. The evolution was unfavourable. This case draws attention to the fact that a displacement of the lateral masses of the atlas can cause a vertebral artery dissection. This occlusion and ischemic symptoms can be delayed. Resonance angiogram or selective angiography should be used to demonstrate vessel dissections, especially for polytraumatised patients.