A Rare Case of Type II Odontoid Fracture With Bilateral Vertebral Arteries Occlusion Without Neurological Deficits

Abstract

Introduction About twenty percent of all cervical spine fractures consist of odontoid fractures. 1,2 The most common odontoid fracture is type II fractures occurring in 65%-74% of cases. 3 According to Anderson and Alonzo, odontoid fractures type II are caused by major trauma or osteoporotic bone quality. 4 In this setting, vertebral artery injury (VAI) had extensively received attention. 5 Cervical subluxations, transverse foramen fractures, and upper cervical spine fractures are also associated with VAI. 6,7 VAI can occur in various situations such as facial hemorrhage, lateralizing neurological dysfunction, as well as cervical hyperextension-rotation or hyperflexion process, closed head injury with diffuse axonal damage, near hanging, and seat belt damage to the back. 7 According to the literature, the prevalence of vertebral artery damage associated with a cervical spinal injury is between 11 and 80%. 8 These vascular injuries cause a wide range of neurological problems for patients. To the best of our knowledge, this is the first report of bilateral vertebral arteries occlusion in type II odontoid fracture, which is founded accidentally in the routine evaluation of patients after a car accident eventuates in fracture without any neurological deficits. Case Presentation This case report had conducted in an academic tertiary hospital and a consent form obtained from our patient. A 42-year-old female presented to our hospital with a history of car rollover four days before presentation. In another hospital, a type II odontoid fracture diagnosis with anterior angulations made, and she has referred to our hospital. She had no significant past medical and surgical history. On admission, she had a stiff collar, and she just complained of neck pain. Her vital signs were blood pressure of 90/60 mm Hg, respiratory rate of 19/min, heart rate of 80/min, and temperature of 37°C. Her physical examinations revealed no abnormal findings. Also, in neurological examinations, she was awake and oriented to time, place, and person. All cranial nerve examinations were normal. Motor and sensory examinations were all normal, and she had no sensory level and paraesthesia. Deep tendon reflexes were 2+. Also, her gait and cerebellar examinations were normal. Laboratory examinations revealed these findings. Normochrome normocytic anemia with hemoglobin: 10.9 (normal range 11-16 g/dL) with mean corpuscular volume (MCV): 88.3 (Normal Range 80-100 fl) and MCH 29.13 (Normal Range 27-35 pg). The hematocrit ratio was 34.1 %, and the platelet count was 271 (10^3/mm^3).

Neurological findings associated with neuroimaging in COVID-19 Patients

“…Prolonged neurological consequences have also not been yet researched. Therefore, additional research is necessary to resolve these unanswered problems [43][44][45][46][47][48] .…”