Traumatic atlanto-axial rotatory subluxation and dens fracture with subaxial SCIWORA of Brown-Sequard syndrome: A case report.
Accidents, Traffic
Atlanto-Axial Joint
/ diagnostic imaging
Brown-Sequard Syndrome
/ diagnostic imaging
Cervical Vertebrae
/ injuries
Child
Humans
Joint Dislocations
/ diagnostic imaging
Ligaments, Articular
/ diagnostic imaging
Male
Neck Injuries
/ diagnostic imaging
Neck Pain
/ diagnostic imaging
Radiography
Rupture
Spinal Cord Injuries
/ diagnostic imaging
Spinal Fractures
/ diagnostic imaging
Torticollis
/ diagnostic imaging
Journal
Medicine
ISSN: 1536-5964
Titre abrégé: Medicine (Baltimore)
Pays: United States
ID NLM: 2985248R
Informations de publication
Date de publication:
23 Apr 2021
23 Apr 2021
Historique:
received:
03
02
2021
accepted:
31
03
2021
entrez:
21
4
2021
pubmed:
22
4
2021
medline:
27
4
2021
Statut:
ppublish
Résumé
A case of traumatic atlanto-axial rotatory subluxation (AARS), dens fracture, rupture of transverse atlantal ligament (TAL), and subaxial spinal cord injury without radiographic abnormality (SCIWORA) of Brown-Sequard syndrome has never been reported in a child. A 7-year-old boy presented to hospital with torticollis, neck pain, and limited neck rotation after a seat-belt injury sustained during a car accident. Neurologic examination revealed right-side motor weakness and left-side sensory abnormality, known as Brown-Sequard syndrome. Radiologic examinations revealed type II AARS (Fielding and Hawkins classification), increased atlanto-dental interval (ADI) of 4.5 mm due to a type 1B TAL rupture (Dickman classification), a displaced transverse dens fracture along with an ossiculum terminale, and an intramedullary hemorrhage on the right side of the spinal cord at C3-4. The patient immediately received methylprednisolone, and his motor weakness and sensory abnormality gradually improved. At the same time, the patient underwent initial halter traction for 2 weeks, but he failed to achieve successful reduction and required manual reduction under general anesthesia. At the 7-month follow-up visit, radiologic examinations showed a corrected type II AARS that was well maintained and normalization of the ADI to 2 mm. The reduced transverse dens fracture was well maintained but still not united. All clinical symptoms were significantly improved, except the remaining motor weakness of the right upper extremity. To the best of our knowledge, this is the first report of traumatic AARS, dens fracture, TAL rupture, and subaxial SCIWORA of Brown-Sequard syndrome in a child. Appropriate diagnosis and careful treatment strategy are required for successful management of complex cervical injuries in a child.
Identifiants
pubmed: 33879718
doi: 10.1097/MD.0000000000025588
pii: 00005792-202104230-00065
pmc: PMC8078422
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e25588Informations de copyright
Copyright © 2021 the Author(s). Published by Wolters Kluwer Health, Inc.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose.
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