case_images: PMC4513296_01
case_images: Paramedics on the scene carefully cut down the tines. The patient's vital signs were stable, and he manifested no neurological deficits
case_images: SNI-6-117-g001.jpg
case_images: PMC4513296_01_SNI-6-117-g001.jpg
case_images: F1
case_images: In a fall on a large rake, this 76-year-old man was stabbed in the left neck by three tines [Figure 1].
case_images: (a) A plain computed tomography (CT) scan (axial view) indicated vertebral artery injury. (b) An enhanced CT scan (coronal view) demonstrated left vertebral artery interruption
case_images: SNI-6-117-g002.jpg
case_images: PMC4513296_01_SNI-6-117-g002.jpg
case_images: F2
case_images: CT angiography (CTA) demonstrated obstruction of the left vertebral artery at the V2 segment proximal to the penetrating tine [Figure 2].
case_images: Digital subtraction angiography showed vertebral artery injury. The left vertebral artery was interrupted at the V2 segment at a site proximal to the tip of the tine (a). The contralateral vertebral artery was perfused on both sides of the posterior circulation (b)
case_images: SNI-6-117-g003.jpg
case_images: PMC4513296_01_SNI-6-117-g003.jpg
case_images: F3
case_images: Angiography through the left vertebral artery revealed obstruction of the left vertebral artery and some oozing beside the metal tine [Figure 3].
case_images: (a) Digital subtraction angiography (DSA) performed after injecting the left vertebral artery via a microcatheter showed extravasation from the vessel upon removal of the tine. (b) DSA performed after injecting the left vertebral artery via a guiding catheter showed no extravasation from the left vertebral artery after embolization. (c) DSA performed after right vertebral artery injection showed good contralateral vertebral artery flow. The damaged vessel was not contrast-enhanced
case_images: SNI-6-117-g004.jpg
case_images: PMC4513296_01_SNI-6-117-g004.jpg
case_images: F4
case_images: Extravasation ceased after complete embolization of the left vertebral artery [Figure 4].
case_images: (a) The axial diffusion-weighted magnetic resonance imaging scan revealed no ischemic region. (b) On the single photon emission computed tomography image, there is no evidence of a decrease in cerebral perfusion in the posterior circulation
case_images: SNI-6-117-g005.jpg
case_images: PMC4513296_01_SNI-6-117-g005.jpg
case_images: F5
case_images: Postoperative magnetic resonance imaging showed no evidence of cerebral infarction and single photon emission CT (SPECT) demonstrated normal cerebral perfusion [Figure 5].