Weekly Case

Title : Case 582

Age / Sex : 17 / M


What is your impression?

Two weeks later, you can see the final diagonosis with a brief discussion of this case (Please submit only one answer).

Courtesy : Jang Gyu Cha, Soonchunhyang University Bucheon Hospital



Discussion


Discussion


Answer: right vertebral artery dissection, cerebellar infarction caused by Os odontoideum



Findings:



Seperation of odontoid process of C2 vertebra and complete fusion of C2-4.


Loss of flow void artifact of right vertebral artery, showing T2 high SI, due to vertebral artery insufficiency.


High SI lesion on DW and low SI on ADC showing vermis infarction



Differential Diagnosis:



Diagnosis:  



Os odontoideum and right vertebral artery dissection, cerebellar infarction



Discussion:


Os odontoideum presenting as atlantoaxial instability may cause symptomatic cord compression; thus, posterior fusion for stabilization is recommended in some cases. Roentogenographically, the presence of translation instability of 10 mm or


more between the atlas and the axis is considered an indication for fusion if the spinal cord symptoms are progressive.


Five cases of os odontoideum associated with pediatric cerebellar infarction have been reported.


Singer et al proposed that repeated subluxation of the atlas on axis may produce kinking, compression, stretching, and


tearing of the intima of the vertebral arteries leading to thromboembolic vertebrobasilar occlusions.


Atlantoaxial instability may cause mechanical stress to the vertebral artery as well as spinal cord injury. More


attention should be paid to the possible relation between atlantoaxial instability and vertebrobasilar artery insufficiency.


References:



Os Odontoideum With Cerebellar Infarction A Case Report


SPINE 2000;25(9): 1178–1181


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Correct Answer
Total applicants 38 Correct answers 25
Name Institution
전성희 전문의
석지현 전문의
이은채 전문의
김기욱 국군대전병원, 전문의
전인환 전문의
이승민 전문의
손상욱 군의관, 전문의
한유비 전문의
서현주 전문의
김태형 전문의
윤유성 삼성서울병원, 전문의
임재정 서울성모병원, 전문의
김형민 전문의
이혜란 전문의
장성원 중앙보훈병원, 전공의
장용석 고려대학교 구로병원, 전문의
김형민 전문의
김유진 전문의
김희정 전문의
김미선 전문의
강지희 서울대학교병원, 전공의
이준형 전문의
김보람 전문의
안태란 전문의


  • 관리자 ( 2018-08-20 16:43:29 )
    atlanto-occipital assimilation, C2-3 block, os odontoideum과 함께 right vertebral artery dissection에 의한 infarction이 있었던 예로, bone abnormality와 함께 cerebellar infarction/ischemia를 함께 쓴 경우만 정답으로 하였습니다. 양해부탁드립니다.

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