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J Korean Soc Emerg Med > Volume 28(2); 2017 > Article
Journal of The Korean Society of Emergency Medicine 2017;28(2): 213-217.
Top of the Basilar Syndrome after 2nd Cervical Spine Fracture
Sun Pyo Kim1, Kyung Hoon Sun1, Seong Jung Kim1, Tae Hoon Kim2
1Department of Emergency Medicine, College of Medicine, Chosun University, Gwangju, Korea
2Department of Emergency Medicine, College of Medicine, Inje University, Busan Paik Hospital, Busan, Korea
Correspondence  Kyung Hoon Sun ,Tel: 062-220-3285, Fax: 062-224-3501, Email: skhkorea@hanmail.net,
Received: November 17, 2016; Revised: November 21, 2016   Accepted: January 2, 2017.  Published online: April 30, 2017.
Top of the basilar (TOB) syndrome occurs with occlusion of the rostral portion of the basilar artery that supplies blood to the midbrain, thalamus, and temporal and occipital lobes. Symptoms associated with TOB include decreased alertness, abnormal eye movement, dysarthria, and disorders of cerebellar function. A 47-year-old man was transferred to our hospital to manage C2 vertebral fracture sustained in a traffic accident. He was alert on arrival; however, he lapsed into semicoma. He was diagnosed with TOB. Thrombolytic agents could not be administered due to a contraindication in cervical spine fracture. Brain magnetic resonance imaging showed acute infarction of the pons, cerebellum, and posterior cerebral artery territory. This rare case demonstrates that C2 vertebral fracture can result in TOB.
Key words: Brain stem infarctions, Spinal fractures, Unconsciousness
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