Radiologic and Clinical Spectrum of Occipital Condyle  Fractures

Hanson, James A.; Deliganis, Anastasia V.; Baxter, Alexander; Cohen, Wendy A.; Linnau, Ken F.; Wilson, Anthony J.; Mann, F. A.

doi:10.2214/ajr.178.5.1781261

Cited by 101 publications

(55 citation statements)

References 24 publications

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“…While their exact incidence is still unknown, they are being recognized more often because of an increased use of CT and MR imaging [16]. To date, their incidence in severely injured trauma patients is estimated between 1% and 2% [7, 14]. The most widely used classification is the one by Anderson and Montesano [2] who divided OCFs into three subtypes.…”

Section: Discussionmentioning

confidence: 99%

“…A type III is an avulsion fracture of the occipital condyle caused by stress on the ipsi- and contralateral alar ligaments and tectorial membrane following forceful hyperextension or hyperflexion at the craniocervical junction. It is considered a potentially unstable fracture [7]. …”

Section: Discussionmentioning

confidence: 99%

“…In most but not all cases, they are associated with severe craniocervical trauma such as a high speed motor vehicle accident or a fall from a substantial height [2]. The clinical presentation of OCFs is highly variable, though severe neurological deficits are more likely due to the associated neurotrauma [7]. We present a patient with an OCF and delayed neurological deterioration due to an extra-axial hemorrhage at the craniocervical junction with fatal injury to the brainstem and upper cervical spinal cord.…”

Section: Introductionmentioning

confidence: 99%

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Unexpected death after occipital condylar fracture

et al. 2017

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We present a rare fatal complication of an occipital condylar fracture. The patient was initially neurologically intact, but showed secondary clinical deterioration. Imaging revealed extensive extra-axial hemorrhage at the craniocervical junction and an acute obstructive hydrocephalus. MR imaging demonstrated a T2 hyperintens signal in both the lower brainstem and upper cervical spinal cord, likely caused by the extra-axial hemorrhage. As prognosis was estimated infaust, supportive treatment was discontinued and the patient died soon thereafter. This case report illustrates a rare, delayed complication and unexpected death in a patient having sustained an occipital condylar fracture.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Unexpected death after occipital condylar fracture

et al. 2017

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“…The anatomical location of the occipital condyles means that the brainstem, the lower cranial nerves (cranial nerves IX–XII) and venous and arterial vessels are at particular risk in the event of fracture. Lower cranial nerve palsies (including Collet–Sicard syndrome where all of the cranial nerves IX–XII are affected) may be acute in two-thirds of cases [35, 41, 45–51]. Delayed cranial nerve palsies may result from migration of fracture fragments or proliferation of fibrous tissue.…”

Section: Craniocervical Junction Blunt Traumatic Injurymentioning

confidence: 99%

The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma

2016

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Imaging of the blunt traumatic injuries to the craniocervical junction can be challenging but central to improving morbidity and mortality related to such injury. The radiologist has a significant part to play in the appropriate management of patients who have suffered injury to this vital junction between the cranium and the spine. Knowledge of the embryology and normal anatomy as well as normal variant appearances avoids inappropriate investigations in these trauma patients. Osseous injury can be subtle while representing important radiological red flags for significant underlying ligamentous injury. An understanding of bony and ligamentous injury patterns can also give some idea of the biomechanics and degree of force required to inflict such trauma. This will assist greatly in predicting risk for other critical injuries related to vital neighbouring structures such as vasculature, brain stem, cranial nerves and spinal cord. The embryology and anatomy of the craniocervical junction will be outlined in this review and the relevant osseous and ligamentous injuries which can arise as a result of blunt trauma to this site described together. Appropriate secondary radiological imaging considerations related to potential complications of such trauma will also be discussed.Teaching points• The craniocervical junction is a distinct osseo-ligamentous entity with specific functional demands.• Understanding the embryology of the craniocervical junction may prevent erroneous radiological interpretation.• In blunt trauma, the anatomical biomechanical demands of the ligaments warrant consideration.• Dedicated MRI sequences can provide accurate evaluation of ligamentous integrity and injury.• Injury of the craniocervical junction carries risk of blunt traumatic cerebrovascular injury.

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“…The stability of occipitoatlantal and atlantoaxial joint was maintained according to the criteria of Hanson's study, which suggest instability when distance of the occipitoatlantal joint is >2 mm or that of the atlantoaxial joint is >3 mm (Fig. 2) [5]. An electrodiagnostic study and a videofluoroscopic swallowing study (VFSS) were performed 25 days after the injury to confirm the degree of damage to cranial nerves.…”

Section: Case Reportmentioning

confidence: 99%

Occipital Condyle Fracture With Isolated Unilateral Hypoglossal Nerve Palsy

et al. 2014

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Occipital condyle fractures (OCFs) with selective involvement of the hypoglossal canal are rare. OCFs usually occur after major trauma and combine multiple fractures. We describe a 38-year-old man who presented with neck pain and a tongue deviation to the right side after a traffic accident. Severe limitations were detected during active and passive range of neck motion in all directions. A physical examination revealed a normal gag reflex and normal mobility of the palate, larynx, and shoulder girdle. He had normal taste and general sensation in his tongue. However, he presented with a tongue deviation to the right side on protrusion. A videofluoroscopic swallowing study revealed piecemeal deglutition due to decreased tongue mobility but no aspiration of food. Plain X-ray film findings were negative, but a computed tomography study with coronal reconstruction demonstrated a right OCF involving the hypoglossal canal. An electrodiagnostic study revealed evidence of right hypoglossal nerve palsy. We report a rare case of isolated hypoglossal nerve palsy caused by an OCF.

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Radiologic and Clinical Spectrum of Occipital Condyle Fractures

Cited by 101 publications

References 24 publications

Unexpected death after occipital condylar fracture

Unexpected death after occipital condylar fracture

The craniocervical junction: embryology, anatomy, biomechanics and imaging in blunt trauma

Occipital Condyle Fracture With Isolated Unilateral Hypoglossal Nerve Palsy

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