Endovascular rescue of vertebro-basilar thrombosis in cervical spine injury

Introduction

Vertebro-basilar thrombosis is often lethal. We report a post-traumatic case in which logistical issues were overcome to secure prompt endovascular intervention resulting in a favourable outcome.

Case presentation

We report this case to highlight (i) the need, across the United Kingdom, for rapid access to 24/7 neurointerventional services and (ii) the fact that vertebral artery injury during C-spine trauma, while not uncommon, can rarely have catastrophic complications.

Discussion

Vertebral artery injuries during C-spine trauma can rarely present as a neurovascular emergency requiring neurointerventional rescue. It is our opinion that patients with neurovascular emergencies merit 24/7 neurointerventional services, akin to those provided for acute coronary syndromes.

Evaluation of an expired fraction carbon dioxide monitor

Respiratory monitoring is an important aspect of critical care, especially in neurosurgery and neuro-intensive care. Fixed capnographs are too cumbersome to allow monitoring during patient transport. Recently several portable expired fraction carbon dioxide devices have been developed, but no evaluation of their clinical peformance has been reported. We compared the Criticare POET LT Handheld expired fraction carbon dioxide monitor, in three different settings, to fixed capnographs and arterial blood gas analysis. A methodology for systematic appraisal of end-tidal capnographs is proposed.