Fractured cervical spine, dissected vertebral artery, and life-threatening stroke: A challenging case report and literature review

•For upper cervical spine (C1 C2 C3) fractures, cervical subluxation, and fracture encompassing the vertebral foramen, a CT angiogram is required.•A patient with a cervical fracture and a VAI must be transferred to a hospital able to deal with ischemic strokes and neurosurgical emergencies.•Antithrombotic therapy (antiplatelet or anticoagulant) should be considered in all cases of blunt traumatic vertebral dissection.•Reactiveness in revascularisation therapy can ensure a full recovery, even in case of life threatening strokes in comatose patients. Vertebral artery injury (VAI) following blunt trauma can lead to acute or delayed life-threatening posterior fossa ischemic stroke. Its management raises controversial issues and is still open to debate. We report the case of a 48-year-old male who presented a life-threatening posterior circulation ischemic stroke, secondary to a vertebral artery dissection caused by a cervical spine fracture. This case was successfully managed through intravenous thrombolysis and endovascular thrombectomy followed by antiplatelet therapy and an anterior cervical discectomy and fusion. At the one-year follow-up, the patient had no persisting deficit and was back working as a policeman. Rapid management of patients with dramatic clinical presentation can lead to full recovery. Implications include a systematic screening of blunt trauma VAI through computed tomography angiography when dealing with high-risk cervical spine fractures; patients harboring both a cervical spine fracture and a VAI must be transferred to a tertiary referral hospital able to deal both with strokes and cervical spine surgery to ensure responsiveness in case of stroke.