Pediatric Atlantoaxial Instability Presenting as Cerebral and Cerebellar Infarcts

Bhatnagar, M; Sponseller, Paul D.; Carroll, Charles; Tolo, Vernon T.

doi:10.1097/01241398-199101000-00020

Cited by 38 publications

(13 citation statements)

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“…Stabilization of the spine may also prevent platelet aggregation, thrombus formation, and embolization, which occur with repeated flexion-extension of the vessels. 3,27 The fact that anterior decompression was limited to odontoidectomy and did not involve decompression of the vertebral artery strongly supports occipito-cervical immobilization as the cause of improvement in VBI in our patients. This finding could be of some significance because there is a recent tendency to take recourse to vascular surgery and/or vertebral artery decompression to augment the vertebral circulation, 24 -25 which, besides being complex and time consuming, is not without significant risks.…”

Section: Table 1 Symptomatic Group Showing the Cerebellar To Basal Gmentioning

confidence: 58%

“…3,27 The clinical rarity of posterior circulation territory infarcts in congenital CVJ anomalies has been historically attributed to the duplication of the vertebral artery and the adequacy of the circulation of Willis in preventing a full-fledged infarct from developing in these patients. 27,28 However, we believe that that this spuriously low incidence may possibly be because patients symptomatic for VBI are not routinely evaluated for CVJ anomalies, which may, therefore, remain undiagnosed. The cerebellar perfusion was considered improved only if the change in ratio was more than 10%.…”

Section: Discussionmentioning

confidence: 99%

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Have Cranio-Vertebral Junction Anomalies Been Overlooked as a Cause of Vertebro-Basilar Insufficiency?

Agrawal¹,

Gowda²,

Bal³

et al. 2006

Spine

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Section: Table 1 Symptomatic Group Showing the Cerebellar To Basal Gmentioning

confidence: 58%

Section: Discussionmentioning

confidence: 99%

Have Cranio-Vertebral Junction Anomalies Been Overlooked as a Cause of Vertebro-Basilar Insufficiency?

Agrawal¹,

Gowda²,

Bal³

et al. 2006

Spine

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show abstract

“…29 In 1991, Bhatnagar et al reported the first incidence of cerebellar infarction arising due to OO. 99 Two more cases were reported in 1994 and 2003 by Miyata et al and Fukuda et al, respectively. 100, 101 Takakuwa et al reported intermittent vertebral artery kinking due to OO in 2 out of 7 patients with craniovertebral anomalies, who suffered from posterior circulation attacks due to asymptomatic OO.…”

Section: Symptomatic Patientsmentioning

confidence: 96%

“…100, 101 Takakuwa et al reported intermittent vertebral artery kinking due to OO in 2 out of 7 patients with craniovertebral anomalies, who suffered from posterior circulation attacks due to asymptomatic OO. 99,[101][102][103] In addition to the above mentioned clinical symptoms, sleep apnea rarely is observed among patients suffering from OO with an anterior atlantoaxial subluxation. In other related cases reported, sleep apnea results on account of the narrowing of the airways due to subluxation.…”

Section: Symptomatic Patientsmentioning

confidence: 99%

Os Odontoideum: Review Article

Rahimizadeh¹

2017

Orthop Res Traumatol Open J

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Os odontoideum (OO) is defined as an ossicle with circumferential smooth margins and no osseous continuity with the body of axis. While the size of the ossicle is variable, it has a smooth surface, therefore, the cause of this condition has been presumed to be both congenital and traumatic. The possible cause of this condition has been implicated in its underlying etiology. However, patients with this condition may be asymptomatic or may be symptomatic of a variety of neurological deficits and vascular dysfunctions. The treatment of both the asymptomatic and symptomatic characteristics of this condition has undergone changes over the past few decades. The most challenging issue encountered is the management of OO with irreducible atlantoaxial dislocation. This outlines the objective of our discussion to examine the aforementioned subject extensively and review the appropriate potential strategies for the treatment of this condition.

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“…5). Even in patients without Down syndrome, the craniocervical junction is an area with a unique anatomy that predisposes it to certain patterns of injury [3, 6, 8, 17-20]. Neonates and infants are particularly prone to injury in this region owing to their disproportionately large head and developing neck musculature [6, 17, 19].…”

Section: Discussionmentioning

confidence: 99%

Dynamic MRI in the Evaluation of Atlantoaxial Stability in Pediatric Down Syndrome Patients

Melamed

Krieger

2019

Pediatr Neurosurg

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Background/Aims: Down syndrome is the most common inherited disorder. Some patients develop atlantoaxial instability. Existing screening guidelines were developed prior to availability of MRI. We present predictors for deficit using dynamic MRI of the craniocervical junction. Methods: A retrospective review of Down syndrome patients from 2001 to 2015 was carried out. Patients were considered symptomatic if they had clinical deficits or signal change on MRI. Measurements were taken at the atlantoaxial junction and structural abnormalities noted. Analysis was performed with SPSS. Results: A total of 36 patients were included. Patients averaged 93 months of age with a follow-up of 57 months. No asymptomatic patients developed myelopathy during follow-up. During dynamic imaging, symptomatic patients had greater changes in space available for the cord (SAC) (5.2 vs. 2.7 mm; p < 0.001) and atlantodental interval (ADI) (2.8 vs. 1.3 mm; p = 0.04). These patients were also more likely to have a bony anomaly (50 vs. 13%; p = 0.03). Conclusion: This study characterizes the range of motion seen on dynamic MRI and provides parameters that can be used to distinguish patients at risk for neurologic injury. Changes greater than 3 mm in ADI or 5 mm in SAC during dynamic MRI or any bony abnormality warrants further investigation. Patients without these features may be able to avoid an unnecessary intervention.

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Pediatric Atlantoaxial Instability Presenting as Cerebral and Cerebellar Infarcts

Cited by 38 publications

References 0 publications

Have Cranio-Vertebral Junction Anomalies Been Overlooked as a Cause of Vertebro-Basilar Insufficiency?

Have Cranio-Vertebral Junction Anomalies Been Overlooked as a Cause of Vertebro-Basilar Insufficiency?

Os Odontoideum: Review Article

Dynamic MRI in the Evaluation of Atlantoaxial Stability in Pediatric Down Syndrome Patients

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