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(Stroke. 1995;26:2194-2196.)
© 1995 American Heart Association, Inc.

Articles

Delayed Onset of Fatal Basilar Thrombotic Embolus After Whiplash Injury

L. Viktrup, MD; G.M. Knudsen, MD S.H. Hansen, MD

From the Department of Neurology (L.V., G.M.K.), Hillerød Hospital, and the Department of Forensic Medicine (S.H.H.), University of Copenhagen (Denmark).

Correspondence to Gitte Moos Knudsen, Department of Neurology N2082, Rigshospitalet University of Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen, Denmark.

Background 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.

Case Description 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.

Conclusions 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.

Key Words: cerebral ischemia, transient • trauma • vertebral artery • whiplash injuries

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