Traumatic Basilar Artery Occlusion Caused by a Fracture of the Clivus. Case Report.

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  • SATO Sumito
    Department of Neurosurgery, Kitasato University School of Medicine
  • IIDA Hideo
    Department of Neurosurgery, International Goodwill Hospital
  • HIRAYAMA Hisashi
    Department of Neurosurgery, Kitasato University School of Medicine
  • ENDO Masataka
    Department of Neurosurgery, Kitasato University School of Medicine
  • OHWADA Takashi
    Department of Critical Care and Emergency Medicine, Kitasato University School of Medicine
  • FUJII Kiyotaka
    Department of Neurosurgery, Kitasato University School of Medicine

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  • —Case Report—

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A 56-year-old man presented with a rare traumatic basilar artery occlusion caused by a fracture of the clivus. He fell from the height of 2 meters and immediately fell into a coma. Head computed tomography (CT) revealed an open depressed fracture, an acute epidural hematoma 1 cm thick in the left middle frontal fossa, and a longitudinal fracture of the clivus. Emergency removal of the hematoma was performed with cranioplasty. Head CT 8 hours 50 minutes after injury showed infarctions in the brain stem, cerebellum, and occipital lobes. Cerebral angiography revealed occlusion of the basilar artery in the middle part of the clivus. The patient died after 3 days. Autopsy revealed that the basilar artery was trapped in the clivus fracture site. Vertebrobasilar artery occlusion due to trapping in a clivus fracture has a very poor prognosis. Diagnosis is difficult and generally only confirmed at autopsy. Cerebral angiography is recommended in a patient in a deep coma without massive brain contusion at the early stage of head injury to identify the possibility of vertebrobasilar artery occlusion in a clivus fracture.<br>

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