PMID- 10199907
OWN - NLM
STAT- MEDLINE
DCOM- 19990520
LR  - 20041117
IS  - 0301-0449 (Print)
IS  - 0301-0449 (Linking)
VI  - 29
IP  - 4
DP  - 1999 Apr
TI  - MRI diagnosis of suspected atlanto-occipital dissociation in childhood.
PG  - 275-81
AB  - 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.
FAU - Grabb, B C
AU  - Grabb BC
AD  - Department of Radiology, The Children's Hospital of Alabama, 1600 7 th Avenue 
      South, Birmingham, AL 35233, USA.
FAU - Frye, T A
AU  - Frye TA
FAU - Hedlund, G L
AU  - Hedlund GL
FAU - Vaid, Y N
AU  - Vaid YN
FAU - Grabb, P A
AU  - Grabb PA
FAU - Royal, S A
AU  - Royal SA
LA  - eng
PT  - Journal Article
PL  - Germany
TA  - Pediatr Radiol
JT  - Pediatric radiology
JID - 0365332
SB  - IM
MH  - Atlanto-Occipital Joint/*injuries/pathology
MH  - Child
MH  - Female
MH  - Humans
MH  - *Magnetic Resonance Imaging
MH  - Male
MH  - Spinal Injuries/diagnosis
EDAT- 1999/04/13 00:00
MHDA- 1999/04/13 00:01
CRDT- 1999/04/13 00:00
PHST- 1999/04/13 00:00 [pubmed]
PHST- 1999/04/13 00:01 [medline]
PHST- 1999/04/13 00:00 [entrez]
AID - 10.1007/s002470050588 [doi]
PST - ppublish
SO  - Pediatr Radiol. 1999 Apr;29(4):275-81. doi: 10.1007/s002470050588.