S U M M AR Y A 28 year old woman presented a syndrome of slow spinal compression evolving over four and a half years at the level Cl-C2 vertebrae due to a solitary osteochondroma of the posterior arch of the atlas which was excised by laminectomy. Radiographs of the skeleton did not show the presence of other osteogenic tumours. This is the fifth case of solitary osteochondroma to be published. Elsewhere, in six cases out of 14, the vertebral lesion formed part of generalised exostoses.Solitary exostoses are a rare cause of spinal cord compression. We have traced only four cases in the literature (Rose and Fekete, 1964;Thomas and Andress, 1971;Mitsumori et al., 1975; Twersky et al., 1975). We report here a fifth case, a young woman aged 28 years, who presented a left Brown-Sequard syndrome secondary to an exostosis of the posterior arch of the atlas. Case reportA 28 year old woman was admitted to hospital irl August 1976 with a four year history of a progressively increasing Brown-Sequard syndrome. On neurological examination a left hemiplegia and a right hypaesthesia to touch and pinprick up to C1-C2 dermatomes were found. During the same period the patient also developed an upper cervical pain which was made worse by rotation of the head.Lumbar spinal fluid did not reveal any albumino-cytological dissociation. Lateral tomographic views of the cervico-occipital region showed, implanted on the lower surface of the atlas, a round, condensed image narrowing the cervical canal at this level (Figure). Lipiodol myelography completed by gas myelography confirmed, in double contrast, that there was compression of the spinal cord by an extradural space-occupying lesion opposite C2 vertebra. No osteogenic lesion was noted in the remainder of the skeleton.
Three cases of painful ophthalmoplegia have been described in which symptoms suggesting a tumor of the orbit justified neuroradiological assessment. Phlebography in each case revealed stenosis of the superior ophthalmic vein in its third portion, and non-opicification of the cavernous sinus. Hirtz incidences revealed contralateral cavernous sinus opacification and venous drainage through the coronary sinus. These neuradiological findings helped to differentiate this syndrome from other affections which have similar signs and symptoms.
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