(Kiosk 1) Unusual Cause of Penetrating Spinal Canal Injury Complicated by Cerebellar Stroke: A Case Report

Case Diagnosis: Cerebellar stroke

Case Description or Program Description: A 40-year-old male without past medical history fell at home while brushing his teeth after ingesting alcohol earlier that night. Due to the fall, the electric toothbrush pierced through the side of his tongue. When presenting to the Emergency Department, he complained of a mild headache and severe throat pain, but his neurological exam was normal. CT scanning of the head and neck located the head of the electric toothbrush 5 cm lateral the tongue, extending through the left C2-3 foramen into the left cervical spinal canal and displacing the spinal cord. Focal hypoattenuation within the left vertebral artery was indeterminate for dissection. After C2-3 laminectomy and foreign body removal, he became unresponsive. Head CT and CTA showed cerebellar ischemia due to vertebral artery dissection and thrombus, transtentorial herniation, and obstructive hydrocephalus, requiring decompressive suboccipital craniectomy and external ventricular drain placement. Associated neurological impairment included truncal ataxia, diplopia, dysphagia, dysarthria. After 14 days of inpatient rehabilitation, his ambulation gradually improved to 50m using a front wheel walker, functional vision improved with eyeglass lens taping, and he was dismissed on a regular diet. He was able to return to work 3 months after injury with mild symptoms.

Setting: Academic center

Assessment/Results: Our patient was fortunate not to have a spinal cord injury but had a traumatic vertebral artery dissection due to the foreign body.

Discussion (relevance): Vertebral artery dissection occurs in young patients after cervical manipulation, yoga, martial arts, and other cervical trauma leading to cerebellar stroke and Wallenberg syndrome.

Conclusions: Cerebellar stroke can occur due to vertebral artery dissection following cervical trauma of inter-oral origin. Effective rehabilitation treatment by a trans-disciplinary team is focused on restoring functional limitations associated with ataxia, dizziness, diplopia, dysphagia, and dysarthria leading to resumption of participation in personal, vocational, and family roles.