A 6-year-old female is described who sustained a fracture of the left occipital condyle after colliding with a car at low speed. The fracture was only visible on thin-slice CT of the neck, which is not routinely recommended in children following a road traffic accident. Fractures of the occipitoantlantoaxial complex are difficult to diagnose by plain radiography, and awareness of this problem needs to be raised among clinicians treating children. Dentomaxillofacial Radiology (2012) 41, 175-176. doi: 10.1259/dmfr/59348986Keywords: children; head injury; occipital condylar fracture; paediatrics Case reportA 6-year-old female trying to cross a road was hit on the left side of the body by a car travelling at a speed of around 20 mph. She did not lose consciousness and stood up by herself. Her mother, who had witnessed the incident from a distance, drove her in her own car to the local casualty department. On arrival she was assessed by a senior house officer and a registrar. She had a short period of anterograde amnesia and complained of nausea and neck pain on the left side. No imaging studies were requested but the child was admitted to the paediatric ward for observation. On the consultant ward round the next morning she complained of pain in the midcervical spine on palpation. She showed abrasions and bruises above the left eye, on the left cheek bone, the right hip and the lower back. A CT of the cervical spine was arranged, which revealed a fracture of the left occipital condyle and of the left occipital bone (Figure 1). No abnormality was seen on a plain lateral radiograph (Figure 2). After discussion with a neurosurgeon it was decided to treat the patient conservatively with a soft collar for 8 weeks. A repeat CT scan 1 week later showed signs of healing and no displacement of the bone fragment. DiscussionThe occipital condyles are two prominences located on the undersurface of the skull on either side of the foramen magnum. Together with the atlas and axis
A prophylactic vitamin K dosage regimen of 1 mg oral vitamin K (Konakion MM Paediatric or Orakay) given to all healthy neonates at birth, combined with daily doses of 50 microg Neokay for 3 months for breastfed babies is well tolerated and acceptable to midwives and parents.
A 14-year-old girl was admitted to hospital with fever, headache, sore throat and abdominal pain. Her blood lymphocyte count and inflammatory markers were raised. Acute Epstein-Barr virus (EBV) infection was suspected and confirmed serologically and by measuring the viral load. On day 7, she developed jaundice with abnormal liver function tests. An abdominal ultrasound scan revealed thickening of the gallbladder and bile duct walls without calculi suggesting acute acalculous cholecystitis. The patient improved slowly with symptomatic treatment, and a repeat ultrasound scan six months later was normal. Acalculous cholecystitis is a rare complication of EBV infection and usually has a good prognosis.
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