Atlas fracture

Atlas fracture

Epidemiology

Classification

Pathophysiology

mechanism

includes hyperextension, lateral compression, and axial compression

Associated conditions

C2 spine fracture

50% have an associated spine injury

40% associated with axis fracture

Treatment

Outcome

Stability dependent on degree of injury and healing potential of transverse ligament.

Case report

A 4-year-old child in whom a penetrating trauma to an immature atlas led to an unusual disjunction of the posterior synchondrosis with atlas fracture displacement of the posterior “hemiarch” that plunged into the dura, resulting in a cerebrospinal fluid fistula.

Praneeth et al. discussed the possible mechanism and considerations in the management of this unique presentation. Such an atypical fracture pattern involving the posterior hemi ring of the pediatric atlas is previously unknown 1).

References

1)

Praneeth K, Karthigeyan M, Salunke P, Ray N. Synchondral Fracture of the Posterior “Hemiarch” of Pediatric Atlas with Cerebrospinal Fluid Fistula following a Penetrating Neck Injury. Pediatr Neurosurg. 2019 Oct 10:1-4. doi: 10.1159/000503109. [Epub ahead of print] PubMed PMID: 31600753.

Wyburn-Mason syndrome

Wyburn-Mason syndrome

Neurocutaneous disordersracemose angioma (Wyburn-Mason syndrome): midbrain and retinal arteriovenous malformations.

When encountering patients with markedly dilated and tortuous retinal vessels, Wyburn-Mason syndrome (WMS) or racemous angiomatosis (phacomatosis) is commonly thought of as the archetypal entity that can produce these findings.

Kisilevsky et al. described a patient with Cantu syndrome with phenotypical findings identical to those seen in patients with WMS and want to highlight this as another entity that can present with tortuous and dilated retinal vessels 1).


As with other intracranial and intraocular vascular lesions (e.g., arteriovenous malformation in Wyburn-Mason syndrome, retinal hemangioblastoma in von Hippel Lindau disease, and choroidal hemangioma in Sturge-Weber syndrome), the presence of a vascular lesion in either location should prompt evaluation for additional pathology 2).

References

1)

Kisilevsky E, Kohly RP, Margolin EA. Dilated and tortuous retinal vessels as a sign of Cantu syndrome. Ophthalmic Genet. 2019 Oct;40(5):453-454. doi: 10.1080/13816810.2019.1666415. Epub 2019 Oct 4. PubMed PMID: 31584310.
2)

Torres G, Kini AT, Al Othman B, Lee AG. Familial Cavernous Hemangioma. J Neuroophthalmol. 2019 Mar 18. doi: 10.1097/WNO.0000000000000778. [Epub ahead of print] PubMed PMID: 30893269.
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