Travmatik kranioservikal bileşke ligamanlarının, beyin sapı oluşumlarının yaralanması ve retroklival hematom: kranioservikal bileşke yaralanmalarında nadir görülen kombinasyon

Year 2017, Volume: 42 Issue: 3, 560 - 563, 30.09.2017

Bilal Egemen Çifçi Gökçen Çoban Çifçi Mahmut Gökdemir Enes Duman

https://doi.org/10.17826/cutf.323991

Abstract

Servikal spinal yaralanmalar pediatrik grupta sık görülmektedir ve anatomik, fizyolojik değişiklikler nedeniyle genellikle kranioservikal bölge etkilenmektedir. Araç içi trafik kazalarında hızlı hiperekstansiyon/hiperfleksiyon travması ligamentöz hasarların ve retroklival epidural hematomun bilinen nedenlerindendir. Amacımız 3 yaş 8 aylık çocuk hastada araç içi trafik kazasında hiperekstansiyon/hiperfleksiyon ve rotasyon travmasına bağlı oluşan, bir arada nadiren görülen apikal ligaman hasarı, retroklival hematom ve şüpheli beyin sapı laserasyonu bulgularını sunmaktır. Hastanın servikal bölgesi Philadelphia boyunluğu ile immobilize edildi. Glaskow Koma Skalası 8 olan hasta 6 aydır pediatrik yoğun bakım ünitesinde tedavi görmektedir.

Keywords

Retroklival hematom, apikal ligaman hasarı, subaraknoid kanama

Traumatic craniocervical junction ligamentous and brain stem injuries and retroclival hematoma: unusual combination of craniocervical junction injuries

Abstract

Cervical spine injuries are common in pediatric population and usually seen in craniocervical junction due to the anatomical and physiological differences. Combination of rapid hyperextension/hyperflexion traumas due to high-speed motor vehicle accident are known to be the reason of ligamentous injury and retroclival epidural hematoma. Our aim is to describe a rare combination injury of the the apical ligament, retroclival epidural hematoma and the suspicion of brain stem slits, due to rapid hyperextension/hyperflexion and rotational trauma with high-speed motor vehicle accident in a 3 year 8 month old girl. The cervical spine was immobilized with a Philadelphia collar. She is still under treatment in the pediatric intensive care unit with a Glascow Coma Scale of 8 for six months.

Keywords

Retroclival hematoma, apical ligament injury, subarachnoid hemorrhage

References

• 1. Adams JH, Graham DI. Diffuse brain damages in non-missile head injury. In Recent Advances in Histopathology. (Eds PP Anthony, RNM MacSween): 241-57. Edinburgh, Churchill Livingstone, 1984.
• 2. Ahn ES, Smith ER. Acute clival and spinal subdural hematoma with spontaneous resolution: clinical and radiographic correlation in support of a proposed pathophysiological mechanism. J Neurosurg. 2005;103:175-9.
• 3. Cordobés F, Lobato RD, Rivas JJ, Muñoz MJ, Chillón D, Portillo JM et al. Observations on 82 patients with extradural hematoma: comparison of results before and after the advent of computerized tomography. J Neurosurg. 1981;54:179-86.
• 4. Fisher CG, Sun JC, Dvorak M. Recognition and management of atlanto-occipital dislocation: improving survival from an often fatal condition. Can J Surg. 2001;44:412-20.
• 5. Kwon TH, Joy H, Park YK, Chung HS. Traumatic retroclival epidural hematoma in a child: case report. Neurol Med Chir. 2008;48:347-50.
• 6. Marks SM, Paramaraswaren RN, Johnston RA. Transoral evacuation of a clivus extradural haematoma with good recovery: a case report. Br J Neurosurg. 1997;11:245-7.
• 7. Meoded A, Singhi S, Poretti A, Eran A, Tekes A, Huisman TA. Tectorial membrane injury: frequently overlooked in pediatric traumatic head injury. AJNR Am J Neuroradiol. 2011;32:1806-11.
• 8. Sun PP, Poffenbarger GJ, Durham S, Zimmerman RA. Spectrum of occipitoatlantoaxial injury in young children. J Neurosurg. 2000;93:28-39.
• 9. Tubbs RS, Griessenauer CJ, Hankinson T, Rozzelle C, Wellons JC 3rd, Blount JP et al. Retroclival epidural hematomas: a clinical series. Neurosurgery. 2010;67:404-6.