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Thread: c5 burst fracture and vertebral artery dissection

  1. #11
    but you think its safe in this case? He doesnt see the neuro til August 31st...
    should I call his office and run it by him?

  2. #12
    Thanks SCI-Nurse.

    I must be very slow taking everything in, but just now I have a new curiosity:its about the vertebral artery.

    July 2011 Left side VA was dissected with a clot, with 100% occlusion.
    Oct 2011, the neurosurgeons decided it is mature enough for ortho surgery to proceed.

    You mentioned that this artery feeds the spinal cord and the back of the brain. What are the functions of the back of the brain? what are the repercussions, long term of blockage of arterial flow to the Spinal cord?

  3. #13
    The vertebral arteries join together at the base of the brain to form the basilar artery, which supplies the brain stem, pons, cerebellum, and then joins up with the Circle of Willis (where most of the other brain arteries join together to supply the upper parts of the brain. Right before the two arteries join, they send off a branch each which join to form the anterior spinal artery. This single artery then travels done the front side of the spinal cord, supplying the front 2/3 of the spinal cord.





    Loss of blood flow completely in the basilar artery can result in profound disability or death due to infarction of the vital centers in the brain stem that control breathing, blood pressure, temperature, and heart rate. Loss of blood flow in the anterior spinal artery usually results in paralysis and loss of temperature, pain, and touch sensation below the level where the blood flow is stopped.

    (KLD)

  4. #14
    this seems pretty critical to understand.
    My 4 main questions:

    1.Does the fact that there is 100% occlusion (via thrombus) in the Left vertebral artery, mean that there is now or potentially will be in the future, loss of blood flow to the basilar artery? Causing the effects you outlined?

    2. what exactly is meant when the neurosurgeon tells us that the blood clot has "matured"? He seems to speak in circles and contradictions. we feel confused.
    On the one hand, up til 2 weeks ago, the clot in the Left VA presented a "catastrophic risk" against orthopedic surgery, but, now, he says the risk has lesssened somewhat due to the fact the clot has now matured and he is comfortable enough to defer the decision for surgery to the orthopedic man.

    3. Are there things we should be aware of while living with an untreated clot in the vertebral artery as well as in the event that we do not have the fusion surgery? Are there movement restrictions? weight restrictions? Nobody is educationg us on these topics.

    4.Does the Vertebral artery blockage constitute a brain injury? Should we seek a brain doctor?

  5. #15
    Quote Originally Posted by careprovider View Post
    this seems pretty critical to understand.
    My 4 main questions:

    1.Does the fact that there is 100% occlusion (via thrombus) in the Left vertebral artery, mean that there is now or potentially will be in the future, loss of blood flow to the basilar artery? Causing the effects you outlined?
    No, not necessarily. The reason you have two is as a back-up. Many people loose flow in one of the two vertebral arteries due to trauma or disease and continue to have perfectly acceptable flow into both the anterior spinal arteries and their basilar artery. Loss of both vertebrals is the problem.

    Quote Originally Posted by careprovider View Post
    2. what exactly is meant when the neurosurgeon tells us that the blood clot has "matured"? He seems to speak in circles and contradictions. we feel confused.
    On the one hand, up til 2 weeks ago, the clot in the Left VA presented a "catastrophic risk" against orthopedic surgery, but, now, he says the risk has lesssened somewhat due to the fact the clot has now matured and he is comfortable enough to defer the decision for surgery to the orthopedic man.
    Generally this means that the clot is no longer growing in size, and may actually have started calcifying somewhat. This makes it less likely to break off and form an ebolus with any manipulation of the artery area.

    Quote Originally Posted by careprovider View Post
    3. Are there things we should be aware of while living with an untreated clot in the vertebral artery as well as in the event that we do not have the fusion surgery? Are there movement restrictions? weight restrictions? Nobody is educationg us on these topics.
    Once you have been given a clearance by the vascular surgeon, generally not. Until then, it is important to avoid straining (valsalva) and any radical movements of the head or neck (extremes of rotation, flexion or extension). Lifting is generally limited more for any fracture precautions than with the vascular issues, but heavy lifting ususally does include some straining and valsalva, so we would limit that until OK'd by the vascular surgeon.

    Quote Originally Posted by careprovider View Post
    4.Does the Vertebral artery blockage constitute a brain injury? Should we seek a brain doctor?
    No, unless there are signs or symptoms that the clot has extended up into the basilar artery itself, or higher, or if the person has brain stem symptoms (blurred vision, respiratory distress, speech problems, etc.) which cannot be explained by SCI only.

    (KLD)

  6. #16
    thank you soooooooooo much!

  7. #17
    update: last week, he had a right hemispheric stroke. We are still very frustrated by the response or lack of clarity offered by his medical team.

    The Ortho doc did not return my call for 4 days, when I called in that he was having stroke symptoms. The neuro doc tried to tell me he was probably just dehydrated, and then referred him to his PCP.

    Once in the ER it was clear that he was having the stroke and was admitted to yale, and the head of the stroke dept commented on the unbelievably poor care, asking things like:

    1. why did he have his halo removed so early?
    2. Why is he in a foam collar with this severe of an injury?
    3. Why did the dr authorise PT to do tractioning and manual adjustments so soon?
    4. The ortho doc quipped, "well at least he's still alive"

    The stroke dr referred us to a different neuro vascular surgeon, whom, it turns out we cannot see because he is already on the team that is apparenently treating him.

    The neuro surgeon refuses to schedule an appouintment with us. We need to be counseled and we need to explore vascular and neurological options and nobody wants to touch this case.

    My poor boyfriend is living in limbo, in pain, in increasing numbness, with brain injuries and we were told to get used to it and expect more strokes and death in the future.

    I cannot believe this.
    What, if any, experience or advice can anyone here offer us? Thank you

  8. #18
    Seek another opinion from a neurosurgeon.

    See an attorney.

    (KLD)

  9. #19

  10. #20
    Senior Member fromnwmont's Avatar
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    I can tell you from past experience the Dr's will go into total CYA mode!! If you already have not, start a very detailed file i bought one of the multi dividing folders i could put all my paper work in for easy reference and so i wouldn't loose any of it.. As soon as the surgeons realized "something" was really wrong after my simple hernia/nerve resection surgery (i couldn't walk) it went something like this, I watched Dr 2 cut the nerve and everything went good then Dr 2 said i watched Dr 1 cut the nerve and everything went good to this day i do not know WHO cut the nerves janitor perhaps... I hope you find some answers and he comes out of this ok..........

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