Clinical Remarks on Acute Post-traumatic Atlanto-Axial Rotatory Subluxation in Pediatric-Aged Patients

Missori, Paolo; Marruzzo, Daniele; Peschillo, Simone; Domenicucci, Maurizio

doi:10.1016/j.wneu.2014.07.020

Cited by 22 publications

(10 citation statements)

References 23 publications

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“…It is rare cause of vertebrobasilar insu ciency that arises from mechanical compression of the vertebral artery by head rotation, severe vertigo, dizziness, right upper extremity tingling sensations and aggravated syncope when she turned her head. Our little patient had some BHS symptoms such as dizziness, vertigo, but she did not had blurred vision when turning the neck ( 8,11,12 ) . Medulloblastoma is the most common malignant brain tumour in childhood.…”

Section: Discussionmentioning

confidence: 73%

Unusual presentation of a medulloblastoma mimicking an AARS (Atlanto axial rotatory subluxation). A case report.

Greggi¹,

Boriani²,

Scarale³

et al. 2020

Preprint

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Background: Atlanto-Axial Rotatory Subluxation is an acquired condition, usually occurring in pediatric patients, because of either trauma or pharyngitis or ear-nose-throat ( ENT) surgery or upper respiratory tract infection. Post-traumatic C1-C2 rotational subluxation in pediatric age is a very frequent event. It mimics benign torticollis but may result in permanent disability. The atlanto-axial rotatory displacement, as defined initially by Fielding and Hawkins in 1977, is classified into four types: Type 1 is the most common form in children. It is a simple rotatory displacement without an anterior shift. Type 2 is potentially more dangerous. It is a rotatory displacement with an anterior shift of 5 mm or less. Type 3 is rotatory displacement with an anterior shift greater than 5 mm. Finally, type 4 is rotatory displacement with a posterior shift. Type 3 and 4 deformities are rare, but neurological involvement or even instant death may follow [Fig. 4] (18). The condition requires prompt diagnosis by thorough examination to avoid any treatment delays. The difficulties for a timely and correct diagnosis and then the correct treatment are described. Case presentation: A 5 year old girl comes to the emergency room with cervical pain and stiffness.This painful state, as mum reports, has been lasted for about ten days, after a mild trauma. The radiographic picture demonstrates a rotary subluxation C1-C2, type 1 according to Fielding and Hawkins classificationThe treatment is head-halter traction with 2kg, and nonsteroidal anti-inflammatory drugs (NSAIDs) . After 2 days the x-ray picture improves, but the painful symptoms persist. An in-depth diagnostic MRI of the cervical spine and brain revealed a medulloblastoma which made an immediate and effective neurosurgical intervention necessary. Conclusions: the C1-C2 rotatory dislocation must always be evaluated with extreme care, without neglecting any clinical and anamnestic information for a correct and timely differential diagnosis. Remember that children show very clearly what they feel, always .

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Section: Discussionmentioning

confidence: 73%

Unusual presentation of a medulloblastoma mimicking an AARS (Atlanto axial rotatory subluxation). A case report.

Greggi¹,

Boriani²,

Scarale³

et al. 2020

Preprint

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“…The cause was identified as stenosis caused by hyper-rotation apophyseal joint subluxation. 9 Missori et al 17 reported on a case of atlantoaxial rotatory subluxation resulting in transient blindness after a neck injury. A limited number of published studies cite ultrasonography as a valuable assessment tool.…”

Section: Discussionmentioning

confidence: 99%

Vascular Ultrasound Measurements After Atlas Orthogonal Chiropractic Care in a Patient With Bow Hunter Syndrome

Rectenwald

DeSimone

Sweat

2018

Journal of Chiropractic Medicine

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Objective: This case report describes chiropractic treatment for a patient diagnosed with bow hunter syndrome with transient vision loss (TVL). Clinical Features: A 39-year-old woman presented to a chiropractic clinic with hand and arm numbness that began after she was injured in a motor vehicle collision 18 months earlier. The primary symptom was TVL that began 3 days after the motor vehicle collision. At that time, she had been diagnosed with bow hunter syndrome using dynamic angiography findings. She had previously declined surgery recommended by her attending neurosurgeon at a local hospital. Intervention and Outcome: The patient was treated using atlas orthogonal chiropractic technique for 8 visits over a 6-week period. Examination before and the after the initial treatment included cervical radiographic analysis and vascular ultrasound measurement of the right and the left vertebral artery (VA). After the initial spinal manipulation, there was an improvement in blood flow volume of 8.2% in the left VA and 22.2% in the right VA. There was improvement of the symptom of TVL and a measured reduction of rotational misalignment of the first and second cervical vertebra on the radiographic views. After 6 weeks, the patient's perception of TVL was absent. Conclusion: A patient with TVL improved under chiropractic care using atlas orthogonal technique.

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“…(1-5) This prevalence occurs because of specific anatomic characteristics of childhood, such as disproportion between head-neck, underdeveloped cervical musculature, laxity of the joint capsule, ligament elasticity and horizontal shape of the articular facets between atlas and axis vertebrae. (3-7) This condition can occur due to inflammation/infection (2,6,7) or trauma, (1,2,4,6) or because of neurogenic or idiopathic origin.…”

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confidence: 99%

“…(2,3,7) In addition, the magnetic resonance image can also be requested to evaluate the risk of vascular-nervous bundle compromising and injuries of the ligaments adjacent to vertebrae. (1,5-7) …”

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confidence: 99%

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Rotation of the second cervical vertebra in pediatric patient

Peyneau

Roque‐Torres

Godolfim

et al. 2016

Einstein (São Paulo)

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Clinical Remarks on Acute Post-traumatic Atlanto-Axial Rotatory Subluxation in Pediatric-Aged Patients

Cited by 22 publications

References 23 publications

Unusual presentation of a medulloblastoma mimicking an AARS (Atlanto axial rotatory subluxation). A case report.

Unusual presentation of a medulloblastoma mimicking an AARS (Atlanto axial rotatory subluxation). A case report.

Vascular Ultrasound Measurements After Atlas Orthogonal Chiropractic Care in a Patient With Bow Hunter Syndrome

Rotation of the second cervical vertebra in pediatric patient

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