A C1 Jefferson Fracture With Vertebral Artery Occlusion and Cerebellar Infarction: A Case Report

Abstract

Jefferson fracture is a C1 fracture, which happens when an axial load is from the occiput downward to the C1 ring. Usually, it causes outward displacement of the C1 arch, which can injure the vertebral artery. We present a Jefferson fracture with vertebral artery injury, resulting in an asymptomatic ischemic stroke of the left cerebellum. Usually, vertebral artery injuries are asymptomatic since the contralateral vertebral artery and the collateral arteries will adequately supply the cerebellum. Vertebral artery injury (VAI) is typically treated with conservative management with anticoagulants and antiplatelet therapy.

Jefferson fracture as sport injury in weight-lifting athlete: A rare case report and literature review

“…Chang D et al described a three-part Jefferson fracture caused by a rear-end collision car accident. [ 11 ] A pedestrian injury and odontoid process breaking through the anterior ring was also reported to create a Jefferson fracture [ 1 , 10 ]. These studies showed other biomechanical points of view and added more spectrum of injury to the fracture.…”

“…The clinical implication of this report was that the treatment options for the Jefferson fracture vary depending on the presence of other cervical injuries related to the main injury. [ 1 , 14 , 22 , 23 ] For a nonoperative treatment, the use of a halo-thoracic brace, rigid collar, or sterno-occipitomandibular immobilization is effective for a stable fracture. [ 1 , 2 , 6 , 14 ] Meanwhile, operative treatment is used for more unstable and complex fracture cases [ 22 ].…”

“…The Jefferson fracture, or fracture of the atlas, is a C1 fracture that leads to the C1 ring outward displacement [ 1 ]. The injury mechanism of the Jefferson fracture is induced by a vertical compression that loads from the occiput through the lateral part of the C1 ring [ [1] , [2] , [3] ]. The injury will cause a fracture of one or both posterior and anterior arches.…”

“…Other cervical injuries commonly accompany this fracture. A potential vascular or neurologic injury could occur if the fracture is not diagnosed or treated immediately [ 1 , 2 ].…”

“…In sport injury, the Jefferson fracture most likely occurs because of a hyperextended neck, such as diving into a shallow pool, a motor vehicle accident, or a face-forward falling injury. Patients with this kind of fracture have a 0,5 % chance of suffering a vertebral artery injury (VIA) [ 1 , 4 ]. Only few studies reported the Jefferson fracture due to sport injury.…”