PubMed · 14653655
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Paul B Freeman. 2003. Sobering thoughts.. https://pubmed.ncbi.nlm.nih.gov/14653655/
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STUDY DESIGN: A case report of traumatic atlanto-occipital dislocation complicated by the development of anterior and posterolateral pseudomeningoceles and the late development of syringohydromyelia is presented. OBJECTIVE: To describe a unique post-traumatic and postsurgical course following atlanto-occipital dislocation. SUMMARY OF BACKGROUND DATA: Syringomyelia is a significant potential long-term complication in patients recovering from traumatic atlanto-occipital dislocation. Cord enlargement and increased T2 signal can be a marker of abnormal cerebrospinal fluid flow dynamics. This "presyrinx state" can be seen before clinical evidence of neurologic compromise. Pseudomeningocele formation after atlanto-occipital dislocation is rare, with only 3 reported cases. To our knowledge, all reported cases describe retropharyngeal pseudomeningoceles, and posterolateral pseudomeningocele as seen in this case has not previously been described. METHODS: A single case is reported with an emphasis on the imaging findings related to the patient's subsequent neurologic deterioration. RESULTS: Following a pedestrian-motor vehicle collision, the patient received initial evaluation and treatment at a local foreign medical facility, where his cervical spine was cleared. Several days following stabilizing treatment and surgery, the patient was transferred to a foreign-based United States military medical facility and ultimately to our institution, where magnetic resonance imaging demonstrated occipitocervical dissociation. The patient was taken to the operating room for surgical stabilization. Four months after his index operation, the patient underwent halo removal. Follow-up magnetic resonance imaging revealed thickening of the cervical spinal cord in conjunction with diffuse high cord T2 signal and a small low cervical segment of syringomyelia. The patient was observed with follow-up magnetic resonance imaging obtained after 1 month. At this time, the low cervical syrinx had enlarged slightly, a small thoracic syrinx was observed, and cine imaging of cerebrospinal fluid flow demonstrated obstruction at the level of the foramen magnum. The patient was taken to the operating room fordecompression of the foramen magnum and posterior fossa and duraplasty. One month later, the patient's clinical condition began to deteriorate, and repeat imaging showed continued enlargement of the patient's syrinx and hydrocephalus. He was admitted for an urgent shunt procedure but unfortunately sustained cardiorespiratory arrest while on the ward awaiting surgery. CONCLUSIONS: Atlanto-occipital dislocation is rarely survivable, and delayed diagnosis can negatively affect long-term clinical outcome. This case illustrates how, despite early signs of improvement, post-traumatic syringomyelia may occur months or even years after spinal trauma and should always be considered in patients who experience late neurologic deterioration after atlanto-occipital dislocation.
OBJECTIVE: To describe the systemic nature of the illness reported after motor vehicle collisions using data from a large, population based cohort of individuals making an injury insurance claim. METHODS: All subjects who submitted a claim or were treated for whiplash injury following a motor vehicle collision in Saskatchewan, Canada during an 18 month period were examined. Demographics of claimants, collision related data, pre-collision health data, symptom prevalence, and scores on the short form 36 item general health survey (SF-36) were obtained on average within one month post-collision. RESULTS: Of 9006 potentially eligible claimants, 7462 (83%) met criteria for whiplash injury and provided information regarding demographics and injury related symptoms; 45% of these consented to complete the SF-36 at baseline. For most subjects, neck pain was only one of many diffuse and intense symptoms, including, often, low back pain. The range of symptoms, including fatigue, dizziness, paraesthesiae, headache, spinal pain, nausea, and jaw pain, could be interpreted as a systemic disorder. SF-36 scores showed low physical and mental functioning one month post-collision. CONCLUSIONS: What is commonly referred to as whiplash associated disorders (WAD) is best appreciated as a syndrome extending well beyond what can be labelled as a neck injury. More research is needed for a better understanding of the underlying mechanisms involved so that treatment can be directed at the broad spectrum of the illness rather than focusing on finding a focal neck injury.
UNLABELLED: The new Brazilian Traffic Code considers drinking and driving as a traffic crime. A health behavior model suggests that much of the young people's risky behavior is not planned and that questions measuring the willingness to drink and drive are useful. In face of the importance of drinking and driving as a national health problem, the objective of the present study was to analyze the behavior willingness among youngsters about to receive their driver's licenses. METHODS: The study was carried out at the Sao Paulo Department of Traffic (DETRAN-SP) in 1998. Data were obtained from a sample of 2,166 youths, 18 to 25 years old, who took the written drivers' license examination. Data about, among other things, alcohol consumption, willingness and alternatives to drinking and driving in the following year was examined. RESULTS: In general, individuals displayed willingness to both the risky behavior (drunk driving) and to the safe behavior (alternatives as taking a cab or getting a ride). Regression analyzes were done by dividing the sample in three groups. Several significant differences were found between the groups, suggesting that the attitudes and behaviors went on a direction from safer to riskier from groups 1 to 3. CONCLUSION: Findings suggest that prevention efforts presenting a spectrum of alternatives to drunk driving and the enforcement of drink and driving laws would be two useful addenda to the more severe laws created in the 1998 Traffic Code.