A Metallic Screw Gun-Traumatic Vertebral Artery Dissection Injury: A Case Report and Literature Review.

Traumatic vertebral artery dissection (VAD) is a tear of the intimal layer, which may extend into the tunica media, resulting in blood tracking within the arterial wall and consequent luminal stenosis. It presents complex challenges for surgical and neurovascular management. The most commonly affected vertebral artery segments are V2 and V3, due to their anatomical vulnerability to mechanical stress during neck motion. Potential complications include ischemic stroke, thromboembolism, subarachnoid hemorrhage, and pseudoaneurysm, which necessitate early diagnosis and timely intervention using endovascular or surgical approaches. We report the case of a 32-year-old previously healthy male who sustained a penetrating cervical injury from a high-speed screw gun. On presentation, he was fully conscious and neurologically intact, complaining of neck pain and restricted range of motion. Initial computed tomography (CT) and computed tomography angiography (CTA) demonstrated a metallic foreign body at the level of the C1-C2 vertebrae involving the right vertebral artery, without evidence of cerebral ischemia. Digital subtraction angiography (DSA) revealed occlusion of the V2 segment of the right vertebral artery with preserved distal flow. Following multidisciplinary discussion, a consensus was reached to proceed with balloon occlusion testing, right vertebral artery coil embolization, and subsequent surgical removal of the foreign body via a suboccipital craniotomy in a staged manner. The postoperative course was uneventful, and the patient was discharged neurologically intact on antiplatelet therapy for secondary stroke prevention. This case illustrates a rare mechanism of traumatic VAD with a favorable clinical outcome. It highlights the critical role of early vascular imaging, multidisciplinary collaboration, and individualized endovascular and surgical management in penetrating vertebral artery injuries.