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Delayed sequelae of vertebral artery dissection and occult cervical fractures

Souers Stroke Institute (Drs. Tulyapronchote, Selhorst, and Gomez) and Section on Neurointensive Care (Dr. Malkoff), Department of Neurology, Saint Louis University Medical Center, St. Louis, MO.

We report three patients who developed delayed (ie, more than a week after the injury) symptoms of vertebrobasilar ischemia following motor vehicle accidents. The patients all had angiographic evidence of vertebral artery dissection and, upon further evaluation, occult fractures of the second cervical vertebra that were not detected by simple cervical spine radiography and required polytomography or CT for diagnosis. Vertebral artery dissection can result from occult cervical spine fractures and may present with delayed symptoms of brain ischemia.

Address correspondence and reprint requests to Dr. Camilo R. Gomez, The Souers Stroke Institute, Department of Neurology, 3635 Vista at Grand, St. Louis, MO 63110.

Received November 23, 1993. Accepted in final form January 28, 1994.

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