RESUMO
Bell's palsy is an acute, ipsilateral facial paralysis secondary to inflammation of cranial nerve VII. This condition is classically caused by herpes simplex virus (HSV); however, many providers will make a diagnosis in the setting of other underlying conditions that are known to cause similar symptoms. The annual incidence of Bell's palsy is 11.5-53.3 per 100,000 persons, with a small subset of individuals being contact sport athletes. A unique challenge to treating Bell's palsy in collegiate athletes is finding a way for these players to return to their sport in a timely fashion, while also avoiding traumatic ocular injuries. Athletic goggles may provide a potential alternative option for athletes to return to the play of their respective sport prior to the physical symptoms subsiding. Due to the prolonged duration of most Bell's palsy symptoms, athletic goggles have the ability to save up to a full season of eligibility for a player. Aside from ocular injuries, a further challenge which encompasses all cases of Bell's palsy is the negative psychosocial effects which accompany the physical symptoms of this condition. Both the patient's physical and psychosocial health considerations must be taken into consideration. In this case report, we review the utility of ocular protection in helping collegiate athletes with unilateral facial paralysis return to play prior to the resolution of symptoms.
RESUMO
BACKGROUND AND PURPOSE: The purpose of this study was to identify and classify the different types of anterior atlanto-occipital membrane complex injuries on MRI and evaluate for the presence, size, and location of a prevertebral effusion on the preceding CT exams. MATERIALS AND METHODS: Patients who suffered an anterior atlanto-occipital membrane complex injury were identified retrospectively utilizing Nuance mPower software. An anatomic-based description of the location of the anterior atlanto-occipital membrane complex injury was recorded along with any additional osteoligamentous trauma of the craniocervical junction. The preceding cervical CT exams for these patients were reviewed for the presence and location of a prevertebral effusion. RESULTS: Fifty patients were identified with an acute, post-traumatic anterior atlanto-occipital membrane complex injury. Three distinct patterns of anterior atlanto-occipital membrane complex injury were observed. Nineteen patients demonstrated increased STIR signal with disruption of the anterior atlanto-occipital membrane, ten patients demonstrated increased STIR signal with disruption of the anterior atlanto-axial membrane, and twenty-one patients demonstrated increased STIR signal with disruption of both the anterior atlanto-occipital membrane and anterior atlanto-axial membrane. An effusion at the C1-C2 level was present in greater than 90% of patients with anterior atlanto-occipital membrane complex injury. CONCLUSIONS: The presence of a craniocervical prevertebral effusion on CT in trauma patients may raise suspicion for an injury to the anterior atlanto-occipital membrane complex and potentially trigger additional investigation with cervical MRI.