Gunshot vertebro-internal jugular fistula

Abstract

A post-gunshot injury, vertebro-internal jugular vein fistula (at the C1 level) in a 38-year-old male is reported. After sustaining a gunshot injury in the cranio-cervical region, the patient developed quadriplegia and 12th nerve palsy. With conservative management, he continued to improve neurologically. Six months after the injury, he developed an arterio-venous fistula between the vertebral venous plexus and the branches of the external carotid artery. It was successfully treated by external carotid artery ligation. He remained symptom-free for nine months when he again developed vertebro-internal jugular vein fistula, documented angiographically. The patient refused surgery. Diagnostic and therapeutic aspects of vertebral arterio-venous fistulae are reviewed.