Pediatric odontoid fracture causing Brown-Sequard syndrome: a case report.

An odontoid fracture leading to Brown-Sequard syndrome (BSS) is an uncommon condition with only seven cases reported to date. To our knowledge, there are no reports of occurrence in paediatric patients. We report a paediatric odontoid fracture leading to Brown-Sequard syndrome (BSS) with satisfactory recovery following surgical treatment. Odontoid fractures may lead to Brown-Sequard syndrome in cases of high-energy trauma in paediatric patients. Direct anterior screw fixation may be a treatment of choice in paediatric odontoid fractures of the comminuted, displaced type when occurring in conjunction with neurologic injuries.

Traumatic atlanto-axial rotatory subluxation and dens fracture with subaxial SCIWORA of Brown-Sequard syndrome: A case report.

RATIONALE: A case of traumatic atlanto-axial rotatory subluxation (AARS), dens fracture, rupture of transverse atlantal ligament (TAL), and subaxial spinal cord injury without radiographic abnormality (SCIWORA) of Brown-Sequard syndrome has never been reported in a child. PATIENT CONCERNS: A 7-year-old boy presented to hospital with torticollis, neck pain, and limited neck rotation after a seat-belt injury sustained during a car accident. Neurologic examination revealed right-side motor weakness and left-side sensory abnormality, known as Brown-Sequard syndrome. DIAGNOSIS: Radiologic examinations revealed type II AARS (Fielding and Hawkins classification), increased atlanto-dental interval (ADI) of 4.5 mm due to a type 1B TAL rupture (Dickman classification), a displaced transverse dens fracture along with an ossiculum terminale, and an intramedullary hemorrhage on the right side of the spinal cord at C3-4. INTERVENTIONS: The patient immediately received methylprednisolone, and his motor weakness and sensory abnormality gradually improved. At the same time, the patient underwent initial halter traction for 2 weeks, but he failed to achieve successful reduction and required manual reduction under general anesthesia. OUTCOMES: At the 7-month follow-up visit, radiologic examinations showed a corrected type II AARS that was well maintained and normalization of the ADI to 2 mm. The reduced transverse dens fracture was well maintained but still not united. All clinical symptoms were significantly improved, except the remaining motor weakness of the right upper extremity. LESSONS: To the best of our knowledge, this is the first report of traumatic AARS, dens fracture, TAL rupture, and subaxial SCIWORA of Brown-Sequard syndrome in a child. Appropriate diagnosis and careful treatment strategy are required for successful management of complex cervical injuries in a child.

Thoracic spinal cord herniation: case report and technical note.

Idiopathic spinal cord herniation and tethering through an anterior dural defect in the thoracic spine is an uncommon but increasingly recognized cause of Brown-Séquard syndrome. High-resolution magnetic resonance imaging is the method of choice to visualize anterior herniation of the spinal cord, although computed tomography myelography may still be performed. Idiopathic spinal cord herniation is a treatable cause of myelopathy. Notably, surgical treatment, consisting of reducing the herniation by closing the dural defect with the use of sutures, or enlarging the dural defect, has been recommended as the procedure of choice, but is difficult to perform in the small space in front of the spinal cord. When the dural defect is enlarged, recurrent transdural herniation may occur. We describe a new technique by wrapping a dura graft, biological glue and haemostatic around the spinal cord to prevent recurrent transdural herniation.

Brown-Sequard syndrome caused by hyperextension in a patient with atlantoaxial subluxation due to an os odontoideum.

Brown-Sequard syndrome is an uncommon complication of atlantoaxial arthrodesis. A 50-year-old female visited our emergency department after falling from a ladder. Radiologic evaluations revealed chronic C1-2 instability with acute spinal cord injury. The day after atlantoaxial fusion was performed, she developed left-sided motor weakness and the loss of right-sided pain and temperature sensation. Based on physical examination and radiologic findings, we diagnosed her as having Brown-Sequard syndrome. Spine surgeons performing this procedure should therefore consider Brown-Sequard syndrome if a patient displays signs of postoperative hemiplegia.

Radiographic classification of Os odontoideum and its clinical significance.

STUDY DESIGN: This study analyzed the relationship between the configuration of the atlantoaxial joint and the clinical characteristics of patients with os odontoideum. OBJECTIVES: To compare three types of atlantoaxial configurations of os odontoideum from the viewpoint of clinical characteristics. METHODS: Twelve patients were classified into the following three types according to their atlantoaxial configuration on an anteroposterior radiogram: round (n = 6), cone (n = 4), and blunt-tooth (n = 2). Clinical features in each group were compared in terms of mean age, gender distribution, severity and type of myelopathy, and degenerative findings of the atlantoaxial joint. RESULTS: The patients in the round type group were predominantly women and had more severe myelopathy than that of patients in the other groups. According to Crandall's classification of myelopathy, all patients showed the transverse lesion syndrome in the cone and blunt-tooth types. Four of six patients with the round type of atlantoaxial configuration had the Brown-Séquard syndrome. With the round type, it appeared that the lateral mass of the axis tended to dislocate laterally, and this lateral instability associated with anteroposterior instability was believed to induced the Brown-Séquard syndrome. CONCLUSIONS: Myelopathy in patients in the round type group was the most severe compared with that of patients in the other three groups. This classification is considered useful for estimating clinical findings in os odontoideum.

Brown-Sèquard syndrome caused by type III odontoid fracture: a case report and review of the literature.

STUDY DESIGN: Case report. OBJECTIVE: To present the second case of Brown-Sèquard syndrome (BSS) produced by type III odontoid fracture managed by conservative treatment. SUMMARY OF BACKGROUND DATA: The occurrence of BSS due to odontoid fracture is scarce. So far 6 cases have been reported, and only 1 is produced by type III odontoid fracture. The possible pathophysiology, clinical course and treatment outcome have been rarely discussed. METHODS: A 39-year-old man presented with weakness of his left arm and leg, mild neck pain, and impaired proprioceptive and light touch sensations below the left C2 dermatome. There were decreased pain and temperature sensations below the right C4 dermatome too. Computerized tomography showed odontoid type III fracture with posterior displacement at that level. Magnetic resonance imaging presented focal hyperintensity around the C2 vertebral level. High dose of prednisolone, close reduction with Gardner-Wells tong skull traction, following external stabilization by Halo-Vest and rehabilitation therapy were applied. RESULTS: Complete resolution of neck pain and significant improvement of motor and sensory functions, i.e., light touch and proprioception, were shown 2 months after spinal injury. Impaired temperature discrimination persisted, however. CONCLUSION: BSS is rarely caused by type III odontoid fracture and this is the second report. Conservative intervention is advantageous for both type III odontoid fracture and BSS which is consistent with previous results.

[Incomplete Brown-Séquard syndrome with Horner syndrome due to plastic foreign body in cervical medulla]. / Inkomplet Brown-Séquards syndrom med Horners syndrom som følge af et plastikfremmedlegeme i medulla spinalis.

A case presentation and discussion of a 32-year old male presenting an incomplete Brown-Séquard syndrome with Horner syndrome due to a plastic foreign body in the cervical medulla.