1/27. Spasmodic torticollis due to neurovascular compression of the spinal accessory nerve by the anteroinferior cerebellar artery: case report.OBJECTIVE AND IMPORTANCE: Spasmodic torticollis is a neuromuscular disorder characterized by uncontrollable clonic and intermittently tonic spasm of the neck muscles. We report a case of spasmodic torticollis attributable to neurovascular compression of the right XIth cranial nerve by the right anteroinferior cerebellar artery (AICA). CLINICAL PRESENTATION: A 72-year-old man with a 2-year history of right spasmodic torticollis underwent magnetic resonance imaging, which demonstrated compression of the right XIth cranial nerve by an abnormal descending loop of the right AICA. INTERVENTION: The patient underwent microvascular decompression surgery. During surgery, it was confirmed that an abnormal loop of the right AICA was compressing the right accessory nerve. Compression was released by the interposition of muscle between the artery and the nerve. CONCLUSION: The patient's postoperative course was uneventful, and his symptoms were fully relieved at the 2-year follow-up examination. This is the first reported case of spasmodic torticollis attributable to compression by the AICA; usually, the blood vessels involved are the vertebral artery and the posteroinferior cerebellar artery.- - - - - - - - - - ranking = 1keywords = accessory nerve, accessory, nerve (Clic here for more details about this article) |
2/27. Delayed closed reduction of rotatory atlantoaxial dislocation in an adult.We report a case of rotatory atlantoaxial dislocation due to a rugby injury in an adult. The patient presented with torticollis 4 weeks after the injury. The neurological evaluation was normal. Reduction proved difficult to obtain and required 10 days of skull traction followed by gentle manipulation. After reduction, dynamic cervical radiographs showed no instability and magnetic resonance imaging (MRI) confirmed that the transverse ligament was intact. After 6 weeks of immobilization in a Minerva jacket, a dynamic rotatory computed tomography (CT) scan confirmed that the atlantoaxial joint was stable. Such cases of atlantoaxial joint dislocation in adults treated by traction after a considerable delay are rare. In our patient, demonstration by MRI that the transverse ligament was intact led to the decision to use conservative therapy, which proved successful.- - - - - - - - - - ranking = 5.2737424272549E-5keywords = injury (Clic here for more details about this article) |
3/27. Combined odontoid and jefferson fracture in a child: a case report.STUDY DESIGN: A case of combined odontoid and Jefferson fracture is reported. OBJECTIVE: To alert spine physicians to the rare combination of an odontoid and Jefferson fracture in a child. methods: A 5-year old boy presented with neck pain and torticollis after falling on his head from a four-wheeler that had rolled over. A computed tomography scan confirmed a combined odontoid and Jefferson fracture. RESULTS: The child was successfully treated nonsurgically with a hard cervical orthosis. At this writing, the child clinically is asymptomatic 2 years after the injury. DISCUSSION: The fall on to the head caused the body weight to be transmitted to the atlas. The resulting force vector produced the classic Jefferson fracture of the atlas. As the atlas fracture spread with continued compressive and axial forces, tension was exerted on the alar ligaments (check ligaments), leading to the avulsion fracture of the odontoid. CONCLUSIONS: This is only the second reported case of a child with a combined Jefferson and odontoid fracture. This diagnosis should be considered in the evaluation of a child with neck pain and torticollis from a fall on the top of the head.- - - - - - - - - - ranking = 2.6368712136274E-5keywords = injury (Clic here for more details about this article) |
4/27. Unilateral globus pallidus internus stimulation improves delayed onset post-traumatic cervical dystonia with an ipsilateral focal basal ganglia lesion.Treatment with unilateral left globus pallidus internus (GPi) deep brain stimulation is reported in a patient with severe delayed onset post-traumatic cervical dystonia. He had sustained severe head trauma at the age of 17 and had developed a mild right hemiparesis. Three years after the head injury, cervical dystonia with head turning to the left side developed. magnetic resonance imaging (MRI) showed a discrete GPi lesion on the left side. At the age of 23, he underwent unilateral left GPi deep brain stimulation. He experienced immediate but short lasting benefit from the microlesioning effect of the electrode. With activation of deep brain stimulation, there was significant improvement of the cervical dystonia, persisting for 12 months of follow up. This case underlines the importance of the globus pallidus internus in the generation and amelioration of cervical dystonia.- - - - - - - - - - ranking = 2.6368712136274E-5keywords = injury (Clic here for more details about this article) |
5/27. Ptosis as a remote effect of therapeutic botulinum toxin B injection.The authors report a patient with cervical dystonia, previously treated with botulinum toxin A (BTX-A), who developed bilateral ptosis and difficulty with accommodation only after botulinum toxin B (BTX-B). High-frequency repetitive nerve stimulation of the abductor digiti minimi demonstrated a 34% increment in compound muscle action potential. No increment in 20 people injected with BTX-A and no cases of ptosis in a chart review of 1,606 BTX-A injections for cervical dystonia were found. The authors conclude that systemic spread of BTX-B can cause symptomatic involvement of autonomic neurons.- - - - - - - - - - ranking = 7.9805198680877E-5keywords = nerve (Clic here for more details about this article) |
6/27. Midshaft clavicle fractures associated with atlantoaxial rotatory displacement: a report of two cases.Two cases of clavicle fractures associated with atlantoaxial rotatory displacement as well as 11 additional cases from the literature are presented. Most cases occur in girls 6 to 10 years old. The head is most often laterally bent toward and rotated away from the fractured clavicle. There is often a delay in making the diagnosis, which is best demonstrated by dynamic CT. Treatment of the clavicle fracture is straightforward, but failure to recognize and treat the C1-2 rotatory displacement promptly can lead to fixed C1-2 deformity. Displacement recognized within the first 3 weeks of injury can be successfully treated nonoperatively. A delay of 6 weeks or greater in the diagnosis leads to fixed deformity at C1-2 that can be addressed with a limited cervical fusion.- - - - - - - - - - ranking = 2.6368712136274E-5keywords = injury (Clic here for more details about this article) |
7/27. Atlantoaxial rotatory subluxation with ankylosis in an 11-year-old girl: a case report.STUDY DESIGN: Report of an 11-year-old girl with a left atlantoaxial rotatory subluxation and ankylosis found 20 months after she sustained a cervical injury. OBJECTIVE: To describe the radiographic characteristics of this rare deformity assessed with a combination of spiral CT scan with multiplanar three-dimensional reformations and functional CT scan. SUMMARY OF BACKGROUND DATA: Atlantoaxial rotatory subluxation is a well-known condition, but its association with lateral C1-C2 ankylosis has not been reported to our knowledge. methods: For a complete assessment of the dislocation, a combined morphologic volumetric and functional CT study was performed. RESULTS: Spiral CT showed an atlantoaxial rotatory subluxation with lateral C1-C2 ankylosis. CT study also demonstrated a lateral C1-C2 subluxation and an ipsilateral occipitoatlantal subluxation. Cervical MRI showed no spinal cord compression despite the seriousness of the dislocation process. CONCLUSIONS: Whereas "classic" spiral study with multiplanar and three-dimensional reformations allows precise assessment of relationships between the upper cervical vertebrae, as well as bony changes, a functional CT study is essential for cervical biomechanic assessment of rotational instabilities of the craniovertebral junction and upper cervical spine.- - - - - - - - - - ranking = 2.6368712136274E-5keywords = injury (Clic here for more details about this article) |
8/27. Traumatic occipital condyle fracture, multiple cranial nerve palsies, and torticollis: a case report and review of the literature.A 32-year-old man sustained a unique combination of injuries: an occipital condyle fracture, left tenth to twelfth cranial nerve palsies, and chronic torticollis secondary to atlantoaxial rotatory fixation. Computed tomography (CT) demonstrated a triangular fragment of bone in the posterior fossa, and three-dimensional CT-reconstructed images confirmed the bone fragment to be from the occipital condyle. The patient made a good recovery with conservative management. Few occipital condyle fractures have been reported, and they should be suspected in patients who sustain painful neck and lower cranial nerve palsy following trauma. CT and plain films are complementary in confirming the diagnosis.- - - - - - - - - - ranking = 0.00047883119208526keywords = nerve (Clic here for more details about this article) |
9/27. natural history of posttraumatic cervical dystonia.We studied a case series of 9 patients with posttraumatic cervical dystonia, in whom involuntary muscle spasms and abnormal head postures occurred within 7 days after cervical injury. patients were examined, treated with botulinum toxin as necessary, and were followed up to 5 years. Based on our observations of these cases, we propose that complex regional pain syndrome (CRPS) could represent a variant of posttraumatic cervical dystonia that may develop over time after the initiation of dystonia.- - - - - - - - - - ranking = 2.6368712136274E-5keywords = injury (Clic here for more details about this article) |
10/27. Fatal case of BOTOX-related anaphylaxis?Anaphylactic drug reactions are rare and often serious events. The Botulinum toxin A, marketed as BOTOX, was recently approved by the food and Drug Administration for cervical dystonia and glabellar wrinkles, after its approved use and success with blepharospasm, strabismus, and disorders of the 7th cranial nerve. It has been well received due to its efficacy in improving facial lines. This case report documents the first death associated with a Botox-lidocaine mixture given to a woman for chronic neck and back pain. Based on the medical records, autopsy, and laboratory findings, the cause of death was determined to be anaphylaxis to the Botox-lidocaine mixture. The history, indications, off-label uses and possible future applications of Botox are reviewed as well as the uses and complications of lidocaine. Although the anaphylaxis cannot be definitively proven to be due to Botox alone, this case warns of an adverse reaction related to Botox, a drug that is rapidly expanding in range of use as well as increased usage.- - - - - - - - - - ranking = 7.9805198680877E-5keywords = nerve (Clic here for more details about this article) |
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