Grisel's syndrome must be suspected in children with painful torticollis associated with an upper tract respiratory infection. The best results are obtained with early conservative treatment, which prevents chronic changes leading to persistent neck pain and deformity, namely atlanto-axial rotatory fixation (AARF). We emphasize the fact that the diagnosis of Grisel's syndrome is mainly clinical, while the diagnostic confirmation of AARF can only be attained by special neuroimaging techniques.

The authors present the case of a 6-year-old girl who developed a right frontal intradiploic meningoencephalocele following an accidental dural tear produced during surgery for craniosynostosis. Although rare, growing skull fractures have been described in at least eight cases following the accidental laceration of the dura mater in the course of craniosynostosis repair. These cases closely resemble those produced by accidental trauma to the growing skull. However, the intradiploic location of a meningoencephalocele following surgery for craniosynostosis has not been documented previously. This patient presented with headache and a frontal tumor of bonelike consistency. Radiographs and computerized tomography scans of the skull revealed an intraosseous cyst, whereas magnetic resonance imaging demonstrated cerebral tissue herniation within the intradiploic tumor. Surgical treatment consisted of duraplasty and cranioplasty, which achieved good functional and cosmetic results. The pathogenesis of this unusual lesion is discussed and compared with the hypotheses advanced for explaining posttraumatic intradiploic cysts.

Background and Purpose-Few genetic modifications have been identified to be associated with subarachnoid hemorrhage (SAH), most of them playing a role in the formation or size of aneurysms. Methods-We evaluated the role of common and functional polymorphisms affecting the main platelet adhesive glycoproteins (GP) (GPIIIa: HPA-1; GPIa: HPA-5 and C807T; GPIb␣: HPA-2 and VNTR) in the risk for development of the disease and in the severity of the onset. The study was performed in 103 patients with SAH, 103 matched controls, and 473 subjects from the general population. Results-The HPA-1b (PlA2) Pϭ0.0187, respectively). The protection of the HPA-1b allele seemed to be exacerbated by the simultaneous presence of the HPA-2b allele. Thus, no patient carried this combination, which was present in 7.8% of controls (Pϭ0.007). Conclusions-We present the first evidence suggesting a protective role for the platelet GPIIIa HPA-1b allele in SAH. The suggested platelet hyper-reactivity determined by this allele could reduce the risk to suffer SAH, specially if the aneurysm is small, attenuate the severity of the hemorrhage, and reduce the clinical grade at presentation. This effect might be amplified by the simultaneous combination with the GPIb␣ HPA-2b allele.

The authors report the case of a 10-year-old boy who sustained an injury to the cauda equina as a result of the accidental penetration of a wooden pencil into the spinal canal. After neuroimaging evaluation to exclude visceral and vascular lesions, the foreign body was removed and the wound was repaired. This is the first report of a cauda equina injury caused by a pencil.