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Avulsion fracture of the tubercle of the atlas is a rare injury which is probably frequently overlooked. The fracture results from hyperextension of the neck against contraction of the long flexors. We describe two different fracture patterns and discuss the anatomical implications thereof.
The transoral approach (Fang and Ong 1962) allows direct free exposure of the atlas and axis. However, a morphologic description of certain structures at risk corresponding to the views at operation has so far been lacking. The present study is intended to fill this gap by giving the surgeon a transoral view of the peripharyngeal structures. This is a further instance of how classical gross anatomy needs to be continuously rediscovered in the light of clinical activities.
Maps not following the syntactical rules of the graphical language entail the risk of being misunderstood. Maps aim at demonstrating spatial patterns and visualizing dividing lines. Representation of tabular values is not a principal goal. Maps should be "seen" as a whole, not be "read" element by element. Some technical aspects of cartography are discussed (distortion of information, grouping of data, adequacy and use of colour). The guidelines for the new Swiss cancer atlas are based on these general principles. A continuous-shading technique avoiding class intervals is being used. It allows the combination of maps and diagrams of different aggregations of the same data using a common shading scale. Indications of significance are integrated into all figures. Geographical maps are enriched by diagrams showing data for 9 cities, 5 language regions, for a grouping by size of community and for a socioeconomical classification of regions. The universal shading scale enables to compare the figures separately and crossways. Relationships not apparent in a traditional map might be revealed.
Pyoderma gangrenosum was first described in 1930 by Brunsting, Goeckermann and O'Leary. Nevertheless we found some illustrations in an atlas on dermatology, published by Marie-Nicolas Devergie in the first half of the 19th century, which appear to be pyoderma gangrenosum. In addition to discussions of typical syphilitic affections of the skin, Devergie's "Clinique de la Maladie Syphilitique" includes illustrations of gangrenous ulcers, which appeared unexpectedly after local and systemic therapy with mercury. Devergie interpreted those enlarging ulcers as a side effect of mercury therapy. Thus we were able to find evidence of pyoderma gangrenosum more than 100 years before first description in 1930. The etiology of this clinical picture is still unsettled. The favorite postulate has been a bacterial genesis which was the subject of numerous publications until the 1960s.
We report the unusual association of a split atlas and an odontoid fracture in a case of a cervical trauma, thus mimicking a complex C1-C2 fracture. The normal embryology of C1 and the literature on this rare malformation are reviewed.
Developmental symptomatic C1 canal stenosis is very rare. We describe the computed tomography (CT) and magnetic resonance imaging (MRI) appearances in a 8-year-old child who presented with progressive upper and lower limb neurological symptoms and in whom imaging revealed the medial posterior hemiarches of a bifid C1 to be inturned and compressing the cervical cord. This particular configuration of the posterior arch of atlas is frequently associated with other craniocervical bony anomalies and presents with neurological symptoms early in life. Early CT or MRI examination of patients with symptomatic posterior arch of C1 defects is necessary, in order to detect such an appearance, since surgical treatment may prevent neurological deterioration.
The case of a bullet retained, without causing neurological symptoms, in the anterior arch of a youth's atlas after a gun had been fired a short distance from his mouth is reported. The patient was managed with external stabilization.
Migraine is a common disabling neurovascular brain disorder typically characterised by attacks of severe headache and associated with autonomic and neurological symptoms. Migraine is caused by an interplay of genetic and environmental factors. Genome-wide association studies (GWAS) have identified over a dozen genetic loci associated with migraine. Here, we integrated migraine GWAS data with high-resolution spatial gene expression data of normal adult brains from the Allen Human Brain Atlas to identify specific brain regions and molecular pathways that are possibly involved in migraine pathophysiology. To this end, we used two complementary methods. In GWAS data from 23,285 migraine cases and 95,425 controls, we first studied modules of co-expressed genes that were calculated based on human brain expression data for enrichment of genes that showed association with migraine. Enrichment of a migraine GWAS signal was found for five modules that suggest involvement in migraine pathophysiology of: (i) neurotransmission, protein catabolism and mitochondria in the cortex; (ii) transcription regulation in the cortex and cerebellum; and (iii) oligodendrocytes and mitochondria in subcortical areas. Second, we used the high-confidence genes from the migraine GWAS as a basis to construct local migraine-related co-expression gene networks. Signatures of all brain regions and pathways that were prominent in the first method also surfaced in the second method, thus providing support that these brain regions and pathways are indeed involved in migraine pathophysiology.
An unusual case of partial aplasia of the posterior arc of the atlas, with persistent posterior tubercle, is presented in a previously healthy individual who sustained a neck trauma. Both plain X-rays and CT findings specified the lesion. Dynamic X-rays in flexion and extension showed an immobile posterior tubercle. The patient did not develop neurological symptoms at any stage during follow-up (1 year).
Two cases of disruption of the transverse ligament of the atlas with concomitant injuries to the cervical medulla are reported. Such injuries are easily overlooked at post-mortem examination, especially because the external injury can be insignificant.
A case of burst fracture of the atlas associated with a type II fracture of the odontoid is presented. In this instance no atlanto-axial instability was detected clinically. Treatment consisted of 1 week of rest in bed followed by 3 months in a collar. Management, though conservative, resulted in full recovery.
A case is reported of median cleft face syndrome with bifid tongue and odontoid peg and failure of formation of the anterior arch of the atlas. These are features which have not been reported previously. The preoperative CT demonstrated its potential to enhance our understanding of complex and rare craniofacial deformities.
Congenital clefts of the anterior and posterior arches of the atlas were demonstrated in a cervical spine CT performed in a case of suspected trauma. Intact cortical margins and lack of adjacent soft tissue swelling are CT indices distinguishing congenital clefts from fractures.
We report a patient with a bipartite atlas that was noted on preoperative skull radiographs for fractures of facial bones.
Simulated deformations and images can act as the gold standard for evaluating various template-based image segmentation and registration algorithms. Traditional deformable simulation methods, such as the use of analytic deformation fields or the displacement of landmarks followed by some form of interpolation, are often unable to construct rich (complex) and/or realistic deformations of anatomical organs. This paper presents new methods aiming to automatically simulate realistic inter- and intra-individual deformations. The paper first describes a statistical approach to capturing inter-individual variability of high-deformation fields from a number of examples (training samples). In this approach, Wavelet-Packet Transform (WPT) of the training deformations and their Jacobians, in conjunction with a Markov random field (MRF) spatial regularization, are used to capture both coarse and fine characteristics of the training deformations in a statistical fashion. Simulated deformations can then be constructed by randomly sampling the resultant statistical distribution in an unconstrained or a landmark-constrained fashion. The paper also describes a model for generating tissue atrophy or growth in order to simulate intra-individual brain deformations. Several sets of simulated deformation fields and respective images are generated, which can be used in the future for systematic and extensive validation studies of automated atlas-based segmentation and deformable registration methods. The code and simulated data are available through our Web site.
BACKGROUND: The combination of odontoid and bilateral transarticular C1-C2 anterior screw fixation is a recent addition in treating C1-type II odontoid fractures. When feasible, it ensures early maximal stability, even if it slightly reduces the mobility of C1-C2 complex. We report a case of combination atlas-type II odontoid fracture that occurred in a 92-year-old man. The instability was treated with odontoid screw fixation and anterior bilateral C1-C2 transarticular screw fixation in a single stage. The aim of the article is to describe the feasibility of "triple" anterior screw fixation in the presence of C1-type II odontoid fracture. METHODS: The diagnosis, treatment, and outcome of a 92-year-old patient with mild tetraparesis caused by C1-type II odontoid fracture were assessed. RESULTS: Cervical x-rays, computed tomographic scan, and magnetic resonance imaging demonstrated a fracture of posterior arch of C1, associated with type II odontoid fracture and with presumable damage of C1 transverse ligament. Magnetic resonance imaging also showed a high cervical centromedullary area slightly hyperintense in T1-weighted images. Treatment consisted of odontoid and bilateral C1-C2 transarticular screw fixation with single anterior approach. The admission neurologic conditions improved and the patient was early mobilized. CONCLUSIONS: The authors suggest that in presence of C1-type II odontoid fracture, the triple anterior screw fixation has to be taken into account as salvage procedure, especially if other methods of stabilization failed or cannot be safely performed. This technique seems to be safety feasible also in old patients, as our report and the experience of others confirm.
Isolated anterior arch atlantal fracture is a rare entity. Two cases of fracture of the atlas following direct oropharyngeal trauma are presented. The importance of careful upper cervical spine evaluation under these circumstances is emphasised, especially if a potential disaster following anaesthetic intubation or surgical head manipulation is to be avoided. Computed tomographic scanning is useful not only to demonstrate the site of fracture but also for visualisation of the spinal canal, especially to exclude intracanalicular bony fragments. The risk of further trauma is minimised due to the ease of patient positioning.
The clinical findings of rotatory subluxation of the atlas are subtle and x-ray films involving the upper cervical segment are difficult to interpret. Nevertheless, patients with rotatory subluxation must be separated from those with "stiff necks," for they require hospital admission for cervical traction if complications are to be avoided. A case is reported and management and diagnosis are reviewed.