Delayed onset of fatal basilar thrombotic embolus after whiplash injury

• Published in: Stroke (1970) Vol. 26; no. 11; pp. 2194 - 2196
• Main Authors: VIKTRUP, L, KNUDSEN, G. M, HANSEN, S. H
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-11-1995; American Heart Association, Inc
• Subjects: Basilar Artery - pathology; Biological and medical sciences; Cerebral Infarction - etiology; Fatal Outcome; Humans; Injuries of the limb. Injuries of the spine; Male; Medical sciences; Middle Aged; Thromboembolism - etiology; Traumas. Diseases due to physical agents; Whiplash Injuries - complications; Human; Nervous system diseases; Diseases of the osteoarticular system; Cerebral embolism; Cardiovascular disease; Traffic accident; Basilar artery; Spine disease; Thrombosis; Trauma; Cerebral disorder; Vascular disease; Case study; Extension; Ischemia; Central nervous system disease; Vertebral artery; Bending; Complication; Cerebrovascular disease; Cervical spine; Brain (vertebrata)
• ISSN: 0039-2499; 1524-4628
• DOI: 10.1161/01.str.26.11.2194

Whiplash injuries are generally seen after rear-end rather than frontal car collisions. Previous reports have documented death up to 8 days after serious whiplash injury. We report a case of lethal basilar thrombotic embolus that occurred 2 months after the patient's injury in a collision.
After whiplash trauma in a car accident, a 50-year-old taxi driver suffered from headache and episodic visual disturbances. Two months after the accident he suddenly lost consciousness and was admitted to the hospital. A CT scan performed at that time was indicative of basilar thrombosis. The patient died 3 days later. The autopsy revealed a thrombosis in the right vertebral artery and a thrombotic embolus in the basilar artery. Microscopically, a lesion of the right vertebral artery was found at the level of the atlantoaxial joint.
We conclude that the whiplash injury caused a lesion of the right vertebral artery, leading to repeated transient ischemic attacks and finally to a fatal basilar thrombotic embolus. We suggest that in patients with disturbances of the vertebrobasilar circulation, attention should be paid to occurrence of neck trauma in the preceding 3 months. Further, anticoagulant therapy should particularly be considered in patients who after suffering neck injuries develop signs of transient ischemic attacks with origin from the posterior cerebral circulation.