Cervical Trauma Patients with Down Syndrome, Case Report

Abstract

Dislocations of the atlantooccipital junction are rarely encountered fatal injuries, and occur with high energy traumas. Although atlantoaxial rotational instabilities are mostly seen after upper respiratory tract infections in children, trauma and congenital causes should be considered as possible conditions.. Atlas fractures comprise 10% of all cervical and 25% of upper cervical injuries. While posterior arch fractures are the most frequently encountered among atlas fractures, Jefferson fractures and burst fractures are less common and the rare type is massa lateralis fractures. Atlantoaxial instability (AAI) and, less often occipitoatlantal instability (OAI) is a part of the spectrum of Down syndrome. As a very important issue, cervical trauma patients presenting to the emergency department should be carefully treated to prevent mortality and morbidity is very important. Computed Tomography is sufficient for diagnosis in suspected cases of cervical fracture and dislocation. However, MRI imaging may be required in conditions of ligament damage and spinal cord compression. In our case with Down Syndrome; the patient had tactile sensitivity on the spinous process on cervical examination. Immoblization was achieved with a collar. In computed tomography, post-traumatic fracture of the C1 vertebral arch was considered. In Down Syndrome, although history, clinical examination and imaging are evaluated as the presence of a C1 fracture, atlantoaxial instability and cervical dysmorphology should be kept in mind in Down syndrome. In these cases, AAI should be ruled out by radiological imaging methods. The most important part of the treatment is making a correct diagnosis. The deterioration of the neurological picture and new pathologies that may be caused by cardiovascular system or respiratory system failures should be prevented.