Vertebral artery injury and delayed midbrain infarction after unusual fracture of transverse foramen of C3 noted by bone scintigraphy

Vertebral artery dissection and thrombosis propagation causing neurologic sequelae is a rare complication of minor neck injury. Partial fracture of the transverse foramen of the third cervical vertebral body (C3) is uncommon. The authors report a case of vertebral artery injury and delayed midbrain infarction after an unusual fracture of only the upper half of the transverse foramen of C3, noted initially by bone scintigraphy. No other fracture was noted. A minor penetrating skin wound of the neck was not thought to be related to the fracture of the transverse foramen. The right lateral inferior edge of C2 was believed to have compressed the upper half of the transverse foramen of C3 by lateral hyperflexion. Innate laxity of the cervical spine at the level of C2 with respect to C3 in pediatric patients supports this belief.