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Baranoski JF, White AC, Chung CY, Catapano JS, De Oliveira Sillero R, Hui FK, Huisman TA, Lawton MT, Abruzzo T. Mechanical disorders of the cervicocerebral circulation in children and young adults. J Neurointerv Surg 2024; 16:939-946. [PMID: 37696598 DOI: 10.1136/jnis-2022-019577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 08/21/2023] [Indexed: 09/13/2023]
Abstract
Mechanical disorders of the cervicocerebral circulation (MDCC) are conditions in which neurological symptoms result from a disturbance of cerebral blood flow attributable to external mechanical forces exerted on extracranial blood vessels by adjacent musculoskeletal structures during head movement that is presumably within a physiological range. The disease spectrum includes bow hunter's syndrome, carotid-type Eagle syndrome, and various dynamic venous compression syndromes. These conditions have distinct phenotypes in children which differ from those expressed in older adults. In contemporary practice, recognition and diagnostic evaluation is the domain of the neuroendovascular specialist. The diagnostic evaluation of MDCC involves significant technical nuance that can be critical to directing appropriate management, particularly in children. This report aims to provide a comprehensive overview of the pathophysiology, anatomical patterns, diagnosis, and treatment for the full spectrum of MDCC that is commonly encountered in clinical practice.
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Affiliation(s)
| | - Andrew C White
- Radiology, Neurosurgery, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Neurosurgery, University of Colorado Denver, Aurora, Colorado, USA
| | - Charlotte Y Chung
- Radiology, New York University Langone Medical Center, New York, New York, USA
| | | | | | - Ferdinand K Hui
- Neuroscience Institute, Queen's Medical Center, Honolulu, Hawaii, USA
| | | | - Michael T Lawton
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
| | - Todd Abruzzo
- Neurosurgery, Barrow Neurological Institute, Phoenix, Arizona, USA
- Radiology, Phoenix Children's Hospital, Phoenix, Arizona, USA
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2
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Spirollari E, Beaudreault C, Ng C, Vazquez S, Chapman E, Clare K, Wang R, Naftchi A, Das A, Lui A, Sacknovitz A, Dominguez JF, Gandhi CD, Tyagi R, Houten JK, Kinon MD. Cervical fusion for adult patients with atlantoaxial rotatory subluxation. JOURNAL OF SPINE SURGERY (HONG KONG) 2022; 8:224-233. [PMID: 35875625 PMCID: PMC9263735 DOI: 10.21037/jss-22-19] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 04/29/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Atlantoaxial rotatory subluxation (AARS) is a rare injury of the C1/C2 junction. It is often associated with trauma in adults. Treatment may depend on the duration of symptoms and clinical presentation, but there is no consensus regarding the ideal management of these injuries. Our objective is to ascertain the prevalence of neurological deficit, complications, and outcomes of patients diagnosed with AARS undergoing cervical fusion (CF) versus those treated without CF. METHODS The 2016-2019 National Inpatient Sample (NIS) was queried using International Classification of Diseases, 10th revision (ICD-10) for adult patients with C1/C2 subluxation. Patients undergoing CF were defined through ICD-10 procedure codes. Baseline health and acute illness severity was calculated using the 11-point modified frailty index (mFI-11). Presenting characteristics, treatment complications, and outcomes were evaluated of CF vs. non-CF patients. RESULTS Of 990 adult patients with AARS, 720 were treated without CF and 270 were treated with CF. CF patients were more often myelopathic. Patients that had undergone CF treatment were negatively associated with having had extensive trauma. Patients undergoing CF experienced significantly longer length of stay (LOS), increased healthcare resource utilization, and decreased inpatient mortality. Sepsis had a negative association with patients that underwent CF treatment while pneumonia had a positive association. CONCLUSIONS Adult patients undergoing CF for AARS demonstrated an increase in healthcare resource utilization but also a significant decrease in mortality. Extent of acute injury appears to have a strong influence on decision making for CF. Further study of decision making for treatment of this rare injury in adults is warranted.
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Affiliation(s)
| | | | | | | | - Emily Chapman
- Department of Neurosurgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | | | | | | | - Ankita Das
- New York Medical College, Valhalla, NY, USA
| | - Aiden Lui
- New York Medical College, Valhalla, NY, USA
| | | | - Jose F. Dominguez
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Chirag D. Gandhi
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Rachana Tyagi
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - John K. Houten
- Department of Neurosurgery, Maimonides Medical Center, Zucker School of Medicine at Hofstra-Northwell, Brooklyn, NY, USA
| | - Merritt D. Kinon
- Department of Neurosurgery, Westchester Medical Center, New York Medical College, Valhalla, NY, USA
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3
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Does alar ligament injury predict conservative treatment failure of atlantoaxial rotatory subluxation in adults: Case report and review of the literature. Spinal Cord Ser Cases 2021; 7:103. [PMID: 34862363 DOI: 10.1038/s41394-021-00464-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 10/28/2021] [Accepted: 11/02/2021] [Indexed: 11/09/2022] Open
Abstract
INTRODUCTION The alar ligament is an important structure in restraining the rotational movement at the atlantoaxial joint. While bony fractures generally heal, rupture of ligaments may heal poorly in adults and often requires surgical stabilization. Atlantoaxial rotatory subluxation (AARS) is a rare injury in adults, and the prognostic importance of the presence of alar ligament injury with regard to the success of nonoperative management is unknown. CASE PRESENTATION A 28-year-old woman presented after a traumatic Type I AARS without evidence of osseous injury, but MRI demonstrated evidence of unilateral alar ligament disruption. Initial conservative management with closed reduction and maintenance in a rigid cervical collar proved unsuccessful, with worsening pain and failure to maintain reduction. She subsequently underwent open reduction and surgical fixation of C1-C2, resulting in resolution of her pain and maintenance of alignment. DISCUSSION Alar ligament rupture may be a negative prognostic indicator in the success of nonoperative management of type I atlantoaxial rotatory subluxation. Additional study is warranted to better assess whether the status of the alar ligament should be considered an important factor in the management algorithm of type I AARS.
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4
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McCollum N, Guse S. Neck Trauma: Cervical Spine, Seatbelt Sign, and Penetrating Palate Injuries. Emerg Med Clin North Am 2021; 39:573-588. [PMID: 34215403 DOI: 10.1016/j.emc.2021.04.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Pediatric cervical spine, blunt cerebrovascular, and penetrating palate injuries are rare but potentially life-threatening injuries that demand immediate stabilization and treatment. Balancing the risk of a missed injury with radiation exposure and the need for sedation is critical in evaluating children for these injuries. Unfortunately, effective clinical decision tools used in adult trauma cannot be uniformly applied to children. Careful risk stratification based on history, mechanism and examination is imperative to evaluate these injuries judiciously in the pediatric population. This article presents a review of the most up-to-date literature on pediatric neck trauma.
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Affiliation(s)
- Nichole McCollum
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, USA.
| | - Sabrina Guse
- Division of Emergency Medicine, Children's National Hospital, 111 Michigan Ave NW, Washington, DC 20010, USA; George Washington School of Medicine and Health Sciences, 2300 I St NW, Washington, DC 20052, USA
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5
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Braga BP, Sillero R, Pereira RM, Urgun K, Swift DM, Rollins NK, Hogge AJ, Dowling MM. Dynamic compression in vertebral artery dissection in children: apropos of a new protocol. Childs Nerv Syst 2021; 37:1285-1293. [PMID: 33155060 DOI: 10.1007/s00381-020-04956-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 10/28/2020] [Indexed: 12/23/2022]
Abstract
PURPOSE Our goals are (1) to report a consecutive prospective series of children who had posterior circulation stroke caused by vertebral artery dissection at the V3 segment; (2) to describe a configuration of the vertebral artery that may predispose to rotational compression; and (3) to recommend a new protocol for evaluation and treatment of vertebral artery dissection at V3. METHODS All children diagnosed with vertebral artery dissection at the V3 segment from September 2014 to July 2020 at our institution were included in the study. Demographic, clinical, surgical, and radiological data were collected. RESULTS Sixteen children were found to have dissection at a specific segment of the vertebral artery. Fourteen patients were male. Eleven were found to have compression on rotation during a provocative angiogram. All eleven underwent C1C2 posterior fusion as part of their treatment. Their mean age was 6.44 years (range 18 months-15 years). Mean blood loss was 57.7 mL. One minor complication occurred: a superficial wound infection treated with oral antibiotics only. There were no vascular or neurologic injuries. There have been no recurrent ischemic events after diagnosis and/or treatment. Mean follow-up was 33.3 months (range 2-59 months). We designed a new protocol to manage V3 dissections in children. CONCLUSION Posterior C1C2 fusion is a safe and effective option for treatment of dynamic compression in vertebral artery dissection in children. Institution of and compliance with a strict diagnostic and treatment protocol for V3 segment dissections seem to prevent recurrent stroke.
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Affiliation(s)
- Bruno P Braga
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA. .,Center for Cerebrovascular Disease in Children, Children's Health, Dallas, TX, USA.
| | - Rafael Sillero
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA.,Center for Cerebrovascular Disease in Children, Children's Health, Dallas, TX, USA
| | - Rosalina M Pereira
- Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA
| | - Kamran Urgun
- Department of Neurological Surgery, University of California Irvine, Orange, CA, USA
| | - Dale M Swift
- Department of Neurological Surgery, UT Southwestern Medical Center, Dallas, TX, USA.,Center for Cerebrovascular Disease in Children, Children's Health, Dallas, TX, USA
| | - Nancy K Rollins
- Center for Cerebrovascular Disease in Children, Children's Health, Dallas, TX, USA.,Department of Radiology, UT Southwestern Medical Center, Dallas, TX, USA
| | - Amy J Hogge
- Center for Cerebrovascular Disease in Children, Children's Health, Dallas, TX, USA.,Anesthesia for Children, Dallas, TX, USA
| | - Michael M Dowling
- Center for Cerebrovascular Disease in Children, Children's Health, Dallas, TX, USA.,Department of Neurology and Neurotherapeutics, UT Southwestern Medical Center, Dallas, TX, USA.,Department of Pediatrics, UT Southwestern Medical Center, Dallas, TX, USA
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6
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Missori P, Currà A, Peschillo S, Paolini S. Letter to the Editor concerning "Rotational vertebral artery occlusion ('bow hunter syndrome')" by Schulz R, Donoso R, Weissman K (Eur Spine J. 2021 Jan 2. doi:10.1007/s00586-020-06, 680-5). EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1387-1388. [PMID: 33661395 DOI: 10.1007/s00586-021-06789-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 02/05/2021] [Accepted: 02/21/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Paolo Missori
- Department of Human Neurosciences, Neurosurgery, Policlinico Umberto I, "Sapienza" University of Rome, viale del Policlinico, 155, 00161, Roma, Italy.
| | - Antonio Currà
- Department of Medical-Surgical Sciences and Biotechnologies, Academic Neurology Unit, Ospedale A. Fiorini, Terracina, LT, "Sapienza" University of Rome, Polo Pontino, Rome, Italy
| | - Simone Peschillo
- Division of Neurosurgery, Department of Neurosciences, Policlinico "G. Rodolico-S. Marco," University Hospital, Catania, Italy
| | - Sergio Paolini
- IRCCS Neuromed-Pozzilli, "Sapienza" University of Rome, Rome, Italy
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Shimazaki T, Yamada K, Sato K, Jimbo K, Nakamura H, Goto M, Matsubara T, Mizokami K, Iwahashi S, Sasaki T, Shiba N. Primary treatment of atlantoaxial rotatory fixation in children: a multicenter, retrospective series of 125 cases. J Neurosurg Spine 2021; 34:498-505. [PMID: 33276329 DOI: 10.3171/2020.7.spine20183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2020] [Accepted: 07/01/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The primary treatment for atlantoaxial rotatory fixation (AARF) remains controversial. The aim of this study was to investigate the primary treatment for AARF and create an algorithm for primary treatment. METHODS The authors analyzed the data of 125 pediatric patients at four medical institutions from April 1989 to December 2018. The patients were reported to have neck pain, torticollis, and restricted neck range of motion and were diagnosed according to the Fielding classification as type I or II. As a primary treatment, 88 patients received neck collar fixation, and 28 of these patients did not show symptom relief and required Glisson traction. Thirty-seven patients were primarily treated with Glisson traction. In total, 65 patients, including neck collar treatment failure patients, underwent Glisson traction in hospitals. RESULTS The success rate of treatment was significantly higher in the Glisson traction group (97.3%) than in the neck collar fixation group (68.2%) (p = 0.0001, Wilcoxon test). In the neck collar effective group, Fielding type I was more predominant (p = 0.0002, Wilcoxon test) and the duration from onset to the first visit was shorter (p = 0.02, Wilcoxon test) than that in the neck collar ineffective group. Using multivariate logistic regression analysis with the above items, the authors generalized from the estimated formula: logit [p(success group by neck collar fixation group)|duration from onset to the first visit (x1), Fielding type (x2)] = 0.4(intercept) - 0.15x1 + 1.06x2, where x1 is the number of days and x2 = 1 (for Fielding type I) or -1 (for Fielding type II). In cases for which the score is a positive value, the neck collar should be chosen. Conversely, in cases for which the score is a negative value, Glisson traction should be the first choice. CONCLUSIONS According to this formula, in patients with Fielding type I AARF, neck collar fixation should be allowed only if the duration from onset is ≤ 10 days. In patients with Fielding type II, because the score would be a negative value, Glisson traction should be performed as the primary treatment.
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8
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Sae-Huang M, Borg A, Hill CS. Systematic review of the nonsurgical management of atlantoaxial rotatory fixation in childhood. J Neurosurg Pediatr 2021; 27:108-119. [PMID: 33036001 DOI: 10.3171/2020.6.peds20396] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 06/18/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Atlantoaxial rotatory fixation (AARF) is an acquired fixed abnormality of C1-2 joint rotation associated with torticollis in childhood. If the condition is left uncorrected, patients are at risk for developing C1-2 fusion with permanent limitation in the cervical range of movement, cosmetic deformity, and impact on quality of life. The management of AARF and the modality of nonsurgical treatment are poorly defined in both primary care and specialized care settings, and the optimal strategy is not clear. This systematic review aims to examine the available evidence to answer key questions relating to the nonsurgical management of AARF. METHODS A systematic review was performed using the following databases: PubMed, MEDLINE, Healthcare Management Information Consortium (HMIC), EMCare, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), British Nursing Index (BNI), and Allied and Complementary Medicine Database (AMED). Search criteria were created and checked independently among the authors. All articles with a radiological diagnosis of AARF and primary outcome data that met the study inclusion criteria were included and analyzed by the authors. RESULTS Search results did not yield any level I evidence such as a meta-analysis or randomized controlled trial. The initial search yielded 724 articles, 228 of which were screened following application of the core exclusion criteria. A total of 37 studies met the full criteria for inclusion in this review, consisting of 4 prospective studies and 33 retrospective case reviews. No articles directly compared outcomes between modalities of nonsurgical management. Six studies compared the outcome of AARF based on duration of symptoms before initiation of treatment. Comparative analysis of studies was hindered by the wide variety of treatment modalities described and the heterogeneity of outcome data. CONCLUSIONS The authors did not identify any level I evidence comparing different nonsurgical management approaches for AARF. There were few prospective studies, and most studies were uncontrolled, nonrandomized case series. Favorable outcomes were often reported regardless of treatment methods, with early treatment of AARF tending to yield better outcomes independent of the treatment modality. There is a lack of high-quality data, and further research is required to determine the optimal nonsurgical treatment strategy.
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Affiliation(s)
- Morrakot Sae-Huang
- 1Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London
| | - Anouk Borg
- 2Department of Neurosurgery, John Radcliffe Hospital, Oxford; and
| | - Ciaran Scott Hill
- 1Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London
- 3University College London Cancer Institute, London, United Kingdom
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9
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Golomb MR, Ducis KA, Martinez ML. Bow Hunter's Syndrome in Children: A Review of the Literature and Presentation of a New Case in a 12-Year-Old Girl. J Child Neurol 2020; 35:767-772. [PMID: 32507079 DOI: 10.1177/0883073820927108] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Bow hunter's syndrome, or occlusion of the vertebral artery with head rotation leading to ischemia and sometimes stroke, is rarely described in children. The authors review the literature and present a new case. METHODS Both OVID dating back to 1946 and PubMed records were reviewed using the terms ("Bow hunter syndrome" OR "bow hunter's") OR "rotational vertebral artery occlusion" combined with "child," and limited to English language. SCOPUS and the bibliographies of cases found in the search were used to identify additional articles. RESULTS Twelve articles were found describing 25 patients; there were 26 patients when combined with our case. Ages ranged from 1 to 18 years. Most (88.5%, 23/26) were male. Medical treatments included aspirin, clopidogrel, abciximab, enoxaparin, warfarin, and cervical collar. Stenting was tried in 2 cases but did not work long-term. Surgical treatments included decompression, cervical fusion, or a combination. We present a new case of a 12-year-old girl with recurrent stroke who had bilateral vascular compression only visible on provocative angiographic imaging with head turn. She was referred for cervical fusion, and abnormal ligamentous laxity was noted intraoperatively. CONCLUSIONS Bow hunter's syndrome is a rare but important cause of stroke since many of the patients experience recurrent strokes before the diagnosis is made. Reasons for the male predominance are unclear. Provocative angiography plays a key role in diagnosis, and both medical treatment and neurosurgical intervention may prevent recurrence.
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Affiliation(s)
- Meredith R Golomb
- Division of Child Neurology, Department of Neurology, 10668Indiana University School of Medicine, Indianapolis, IN, USA
| | - Katrina A Ducis
- Division of Pediatric Neurosurgery, Department of Neurosurgery, 10668Indiana University School of Medicine, Indianapolis, IN, USA
| | - Mesha L Martinez
- Division of Neuroradiology-Neurointerventional Radiology, Department of Clinical Radiology and Imaging Sciences, 10668Indiana University School of Medicine, Indianapolis, IN, USA
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10
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Munguía VE, Nduku VT, Arnold AD, Gangadharan M. Case 4: Intermittent Nausea and Vertigo in a Healthy 7-year-old Boy. Pediatr Rev 2020; 41:427-429. [PMID: 32737257 DOI: 10.1542/pir.2017-0291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
| | | | | | - Meera Gangadharan
- Department of Pediatric Anesthesiology, Driscoll Children's Hospital, Corpus Christi, TX
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11
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Cohen NT, Harrar DB, Diab YA, Pearl MS, Murnick JG. Atlanto-occipital ligament calcification: a novel imaging finding in pediatric rotational vertebral artery occlusion. Pediatr Radiol 2020; 50:137-141. [PMID: 31511914 DOI: 10.1007/s00247-019-04515-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Revised: 08/04/2019] [Accepted: 08/20/2019] [Indexed: 11/27/2022]
Abstract
We describe a 2-year-old girl with bow hunter syndrome complicated by vertebral artery dissection and multiple ischemic infarcts. Pediatric bow hunter syndrome is a rare and likely under-recognized disorder. Interestingly, our patient had atlanto-occipital ligament calcification on CT scan, an imaging finding that has not been reported in association with bow hunter syndrome and one that might help increase recognition of this dynamic disorder of the posterior circulation.
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Affiliation(s)
- Nathan T Cohen
- Division of Neurology, Children's National Health System, 111 Michigan Ave. NW, W4-800, Washington, DC, 20010, USA.
| | - Dana B Harrar
- Division of Neurology, Children's National Health System, 111 Michigan Ave. NW, W4-800, Washington, DC, 20010, USA.,Departments of Neurology and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Yaser A Diab
- Division of Hematology/Oncology, Children's National Health System, Washington, DC, USA.,Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
| | - Monica S Pearl
- Division of Interventional Neuroradiology, Department of Radiology, The Johns Hopkins University School of Medicine, Baltimore, MD, USA.,Division of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC, USA
| | - Jonathan G Murnick
- Division of Diagnostic Imaging and Radiology, Children's National Health System, Washington, DC, USA.,Department of Radiology and Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, DC, USA
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12
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Unal TC, Dolas I, Unal OF. Unilateral Alar Ligament Injury: Diagnostic, Clinical, and Biomechanical Features. World Neurosurg 2019; 132:e878-e884. [DOI: 10.1016/j.wneu.2019.07.198] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 07/25/2019] [Accepted: 07/26/2019] [Indexed: 10/26/2022]
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13
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Patankar AP. Vertebro-basilar stroke due to Bow-Hunter syndrome: an unusual presentation of rotatory atlanto-axial subluxation in a fourteen year old. Br J Neurosurg 2019:1-3. [PMID: 31544538 DOI: 10.1080/02688697.2019.1668538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
Bow Hunter's syndrome is a rare disorder usually producing transient ischemic symptoms as a result of dynamic compression of the vertebral artery during head turning. We report a case of a 14 year old male presenting with stroke due to occlusion of vertebral artery due to rotatory atlanto-axial subluxation. The patient presented with sudden onset vertigo and ataxia. History revealed led mild torticollis since childhood which was never investigated. MRI and MRA showed infarcts in the bilateral cerebellar hemispheres and the occipital lobes with a hypoplastic left vertebral artery and kinking of the right vertebral artery at the cranio-vertebral junction due to rotatory atlanto-axial subluxation. The patient was successfully treated by C1 lateral mass and C2 sub-facetal screw with rod fixation. Bow-Hunter's syndrome producing transient ischemia is well reported but stroke in the vertebro-basilar territory in a 14 year old due to rotatory atlanto-axial subluxation is uncommon, and to the best of our knowledge, this is the eighth such reported case.
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14
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Rectenwald RJ, DeSimone CM, Sweat RW. Vascular Ultrasound Measurements After Atlas Orthogonal Chiropractic Care in a Patient With Bow Hunter Syndrome. J Chiropr Med 2019; 17:231-236. [PMID: 30846915 DOI: 10.1016/j.jcm.2018.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 04/26/2018] [Accepted: 07/03/2018] [Indexed: 11/28/2022] Open
Abstract
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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Affiliation(s)
| | | | - Roy W Sweat
- Chiropractic Sciences, College of Chiropractic, Life University, Marietta, Georgia
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15
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Santin MDN, Cebula H, Ollivier I, Todeschi J, Baloglu S, Proust F. Diagnosis and suggested treatment against an isolated unilateral rupture of the alar ligament - Concerning one case. Neurochirurgie 2017; 63:478-482. [PMID: 29122308 DOI: 10.1016/j.neuchi.2017.07.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2017] [Revised: 07/10/2017] [Accepted: 07/28/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND An isolated rupture of the alar ligament is a rare occurrence with only a few cases reported in the literature. CASE REPORT The objective was to report the case of a young man with a unilateral rupture of the alar ligament that we closely monitored, clinically and radiologically, in order to describe the evolution of the alar ligament lesions. CONCLUSION Radiological diagnosis using cervical MRI and duration of the conservative treatment remain debated and we proposed a close radiological follow-up in order to best understand the nature of these ligament lesions and their evolution following specific treatment.
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Affiliation(s)
- M-D-N Santin
- Service de Neurochirurgie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France.
| | - H Cebula
- Service de Neurochirurgie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | - I Ollivier
- Service de Neurochirurgie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | - J Todeschi
- Service de Neurochirurgie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | - S Baloglu
- Service de Neuroradiologie (Radiologie 2), hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
| | - F Proust
- Service de Neurochirurgie, hôpital de Hautepierre, hôpitaux universitaires de Strasbourg, 67098 Strasbourg, France
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Eghbal K, Derakhshan N, Haghighat A. Ocular Manifestation of a Cervical Spine Injury: An Adult Case of Traumatic Atlantoaxial Rotatory Subluxation Manifesting with Nystagmus. World Neurosurg 2017; 101:817.e1-817.e3. [PMID: 28254538 DOI: 10.1016/j.wneu.2017.02.064] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2016] [Revised: 02/09/2017] [Accepted: 02/11/2017] [Indexed: 10/20/2022]
Abstract
BACKGROUND Atlantoaxial rotatory subluxation (AARS) is a rare type of traumatic cervical spine injury in adults, commonly manifesting with painful torticollis and suboccipital headache. Early diagnosis is mandatory to avoid catastrophic consequences. We report a rare case of a patient with AARS who presented with nystagmus due to rotational vertebral artery occlusion. CASE DESCRIPTION A 35-year-old man was evaluated in the emergency department after falling from 9-m height. In the intensive care unit, left-sided torticollis and nystagmus were noted in the patient. Reassessment of the patient with cervical computed tomography scans revealed AARS type 1. After applying cervical traction and confirmation of partial reduction, the nystagmus resolved, and treatment was continued with posterior C1-2 fusion. CONCLUSIONS Careful neurologic examination is of paramount importance in diagnosis and management of cervical spine injuries. Nystagmus, as a well-known manifestation of rotational vertebral artery syndrome, can be the presenting symptom of AARS.
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Affiliation(s)
- Keyvan Eghbal
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Nima Derakhshan
- Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Ali Haghighat
- Orthopedic Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran
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Peyneau PD, Roque-Torres GD, Godolfim LR, Costa EDD, Almeida SMD, Ambrosano GMB. Rotation of the second cervical vertebra in pediatric patient. EINSTEIN-SAO PAULO 2016; 14:575-576. [PMID: 28076609 PMCID: PMC5221388 DOI: 10.1590/s1679-45082016ai3631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2016] [Accepted: 04/12/2016] [Indexed: 11/22/2022] Open
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18
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Yu Z, Yu S, Liu R. Letter to the Editor: Bow hunter's syndrome: surgery or conservative therapy? Neurosurg Focus 2015; 39:E6. [PMID: 26646930 DOI: 10.3171/2015.7.focus15331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Zhe Yu
- Chinese PLA General Hospital, Beijing, China
| | | | - Ruozhuo Liu
- Chinese PLA General Hospital, Beijing, China
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