case_images: PMC10849065_01
case_images: CT angiogram displaying an expansile lytic lesion of the C2 vertebral body and moderate, focal compression of the distal right V2 segment with severe stenosis of the proximal left V2.
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case_images: FIG1
case_images: The complete loss of enhancement of the left vertebral artery at the C2 level with short segment reconstitution at the C1 level and long segment narrowing and mural thickening of the left V3 segment highly suggested dissection of the left vertebral artery (Figure 1).
case_images: CT angiograms indicating the point of vertebral artery dissection and complete loss of contrast enhancement of the left vertebral artery at the C2 level. . There is a long segment of narrowing with mural thickening of the left V3 segment indicative of a VA dissection, vessel comes to a tapering point as it is compressed by the pathological fracture of C2, and moderate focal extrinsic compression of the distal right V2 segment due to pathologic fracture of C2.
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case_images: PMC10849065_01_cureus-0016-00000051870-i02.jpg
case_images: FIG2
case_images: The coronal and sagittal CTA indicates the point of VA dissection (Figure 2).
case_images: MRA of the head and neck illustrating no flow signal of the entirety of the left vertebral artery.
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case_images: FIG3
case_images: T1 hyperintense signaling at the left V2 (Figure 3). These MRA findings further supported the theory of left cervical VAD and possibly an intramural hematoma at V2.
case_images: MRI of the cervical spine exhibiting the expansile marrow-displacing, enhancing process involving the C2 and odontoid process.
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case_images: FIG4
case_images: However, MRI of the cervical spine illustrated an expansile marrow replacing enhancing process involving the C2 and odontoid that would cause severe spinal canal stenosis and compression of the spinal cord (Figure 4).