MRI diagnosis of suspected atlanto-occipital dissociation in childhood |
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Authors: | Brenda C Grabb T A Frye G L Hedlund Yoginder N Vaid Paul A Grabb Stuart A Royal |
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Institution: | (1) Department of Radiology, The Children's Hospital of Alabama, 1600 7 th Avenue South, Birmingham, AL 35233, USA, US;(2) Department of Neurosurgery, University of Alabama at Birmingham, 619 South 19 th Street, Birmingham, AL 35233, USA, US |
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Abstract: | Objective. To demonstrate the utility of magnetic resonance (MR) imaging in the diagnosis of complete and partial ligamentous injuries
in patients with suspected atlanto-occipital dissociation (AOD). Materials and methods. Five patients with suspected AOD had MR imaging performed within an average of 4 days after injury. MR scans were reviewed
with specific analysis of craniocervical ligamentous structures. Charts were reviewed to obtain clinical information regarding
presentation, treatment, hospital course, and outcome. Results. Two patients demonstrated MR evidence of complete AOD. One had disruption of all visualized major ligamentous structures
at the craniocervical junction with anterolisthesis and evidence of cord damage. The second had injuries to the tectorial
membrane, superior band of the cruciform ligament, apical ligament, and interspinous ligament at C 1–2. The remaining three
patients sustained incomplete severance of the ligamentous structures at the craniocervical junction. All patients demonstrated
subtle radiographic findings suggestive of AOD, including soft tissue swelling at the craniocervical junction without fracture.
The two patients with complete AOD died. The three patients with partial AOD were treated with stabilization. On follow-up,
these three children were asymptomatic following their craniocervical injury. Conclusion. MR imaging of acute AOD provides accurate identification of the craniocervical ligaments injured, classification of full
versus partial ligamentous disruption, and analysis of accompanying spinal cord injury. This information is important for
early appropriate neurosurgical management and preservation of neurologic function in survivors.
Received: 11 February 1998 Accepted: 20 November 1998 |
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