[Traumatic orbital encephalocele in an adult: report of one case]. / Encéphalocèle intraorbitaire post-traumatique chez un adulte: à propos d'un cas.

Orbital roof fractures after head injury is rare. Traumatic encephaloceles in the orbital cavity are even rarer, with only 24 cases published to date. We report the case of an adult with a post-traumatic orbital encephalocele. One day after a road traffic accident with head injury, the patient developed progressive pulsatile proptosis. Computed tomography and magnetic resonance imaging revealed an isolated blow-in fracture of the orbital roof with herniation of the left frontal lobe into the orbit. Neurosurgery to repair the orbital defect led to full recovery.

[Fracture luxation of the cervical spine in patients with ankylosing spondylitis: six cases]. / Fracture luxation du rachis cervical chez des patients atteints de spondylarthrite ankylosante: à propos de six cas.

BACKGROUND AND PURPOSE: Treatment of cervical spine fracture in patients with ankylosing spondylitis is difficult. Biomechanical changes related to ossified ankylosing spondylitis spine make cervical spine fractures highly unstable. They cover the entire width of the spine inducing multidirectional instability and the risk of neurological injuries. Treatment is more difficult that in the nonossified spine. Different treatments have been proposed including anterior stabilization, posterior stabilization, or both. METHODS: We reviewed retrospectively six cases of cervical fracture dislocation in patients with ankylosing spondylitis. RESULTS: There were five cases of C6C7 fracture dislocation and one case of C4C5 fracture dislocation. Four patients had neurological impairment at diagnosis. All patients underwent surgery. Two had anterior stabilization: one patient died and the other achieved bone healing. Four patients had anterior and posterior stabilization combined with a cervical brace for three months, for two and a halo cast for two, others because of persistent instability, with neurological injury in one. A neurological improvement was obtained in four patients. One patient was lost to follow-up. CONCLUSION: Surgical management of selected patients with ankylosing spondylitis and cervical spine fractures is challenging. Combined anterior and posterior stabilization should be considered for these fractures. A cervical brace must be associated with surgical treatment. With appropriate management, outcome can be favorable.

Unstable upper pediatric cervical spine injuries: report of 28 cases and review of the literature.

OBJECTIVE: Traumatic lesions of upper cervical spine are rare in children. To evaluate their experience with this lesions and factors affecting outcome, authors conducted a retrospective study of 28 cases of upper pediatric cervical spine injuries treated in the last 25 years. MATERIALS AND METHODS: To help in treatment of these lesions, we studied our series and reviewed the literature. Patients were divided into three groups: 0 to 2, 3 to 8, and 9 to 16 years, and managed according to status at presentation and type of injury. RESULTS: Seven patients were managed surgically and 21 nonsurgically (3 halo braces, 18 hard collars or molded braces). Patients in the younger age group sustained more neurological injuries than the others. In group 1, 33% present a fracture/luxation of C0/C1 or odontoid. In group 2, 80% had sustained fracture/luxations of C2. In group 3, 60% present odontoid fractures. At late follow-up review, solid fusions were demonstrated in all patients. Neurological deterioration occur in six patients. The mortality rate was 12%. Compared with other authors' report, incidence of this lesions increased but not the number of those managed surgically. CONCLUSIONS: Management must be tailored to the patient's age, neurological status, type, and level of injury. Compared with other author's experience, fusion and instrumentation procedures were used less frequently. Signs of medullary compression, significant spine deformation, dynamic instability, and age higher than 8 years are the criteria for surgery. The criteria for instability in children are different from those used in adults because the residual spinal growth is a major concern. The best treatment is therefore preventive.

[Main temporal aspects of the MRI signal of subdural hematomas and practical contribution to dating head injury]. / Principaux aspects évolutifs du signal des hématomes sous-duraux en IRM et intérêts pratiques dans la datation des traumatismes crâniens.

BACKGROUND AND PURPOSE: MRI signal of a subdural hematoma (SDH) is often regarded as similar to that of an intracerebral hematoma but no precise study has analyzed the evolution of the signal of subdural hematomas. Their dating is however significant, in particular in the child, within the context of the diagnosis of child abuse. The objective of this study is to compare with MRI a group of adult patients having a subdural and/or intracerebral, in order to study the evolution of the signals of these two types of hematomas. MATERIAL AND METHODS: This prospective study included patients hospitalized for post-traumatic acute subdural or intracerebral hematoma. The protocol included an emergency brain CT and 4 MRI at fixed times: in emergency (early phase), between the third and the seventh day (early subacute phase), during the third week (late subacute phase), and after four months after the hemorrhage. The protocol included T1-weighted sequences before and after injection of gadolinium, T2-weighted, fluid-attenuated inversion-recovery (FLAIR), gradient echo and diffusion. RESULTS: Eighteen patients were included and all 72 MRI were interpretable. The time course of the cerebral hematomas was similar to that described in the literature, whereas that of subdural hematomas was different in 15 patients. This distinction was significant in the early phase for subdural hematomas, which displayed hypersignal in T2 and FLAIR, whereas cerebral hematomas showed a hyposignal in the same sequences. The variation was also notable in the early subacute period during which subdural hematomas displayed hypersignal in T1, FLAIR and diffusion, and isosignal in T2, whereas cerebral hematomas showed isosignal in T1, and hyposignal in T2, FLAIR and diffusion. CONCLUSION: The time course of MRI signal of subdural hematomas is different from that of cerebral hematomas. This difference is significant in T2 sequence and FLAIR, especially in the early subacute period. These radiographic observations in adults can be useful for the MRI dating of subdural hematomas in shaken-baby syndrome.