C1–C2 Instability Associated with Periodontoid Inflammatory Tissue Leading to Subarachnoid Hemorrhage: A Case Report and Review of the Literature
Abstract The authors present a case of atlantoaxial instability associated with C1–C2 inflammatory tissue leading to subarachnoid hemorrhage. A 65-year-old male patient arrived in June 2011 to the emergency unit for cervical pain and fever. Imaging studies documented periodontoid pseudotumor at C1–C...
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Thieme Medical and Scientific Publishers Pvt. Ltd.
2015-12-01
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| Series: | Indian Journal of Neurosurgery |
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| author | Riccardo Draghi Lorenzo Giammattei Pietro Scarone Giordano Lanfranchi Angelica Bava Mauro Pluderi |
| author_facet | Riccardo Draghi Lorenzo Giammattei Pietro Scarone Giordano Lanfranchi Angelica Bava Mauro Pluderi |
| author_sort | Riccardo Draghi |
| collection | DOAJ |
| description | Abstract
The authors present a case of atlantoaxial instability associated with C1–C2 inflammatory tissue leading to subarachnoid hemorrhage. A 65-year-old male patient arrived in June 2011 to the emergency unit for cervical pain and fever. Imaging studies documented periodontoid pseudotumor at C1–C2 level. Infective disease was suspected; the patient was therefore hospitalized and treated with antibiotics. Subsequent computed tomographic (CT) scans revealed C1–C2 instability. In August, the patient showed acute neurological deterioration and coma. Urgent brain CT revealed a hemorrhagic lesion which caused compression on the medulla oblongata, subarachnoid hemorrhage, and ventricular dilatation. An external ventricular drainage was positioned. Angio-CT and angiography did not show any vascular abnormalities. Cervical magnetic resonance imaging documented a solid tissue lesion between the atlas arch and axis. The lesion was associated with an epidural and subdural hematoma, exerting compression on brainstem. The patient underwent posterior decompression and C1–C2 fusion according to Harms technique in October, with significant clinical improvement. The authors present a case of atlantoaxial instability associated with a periodontoid pseudotumor at C1–C2 level determining dural sac compression. The patient showed an acute neurological deterioration caused by bleeding of the solid component of the cervical lesion. Hemorrhage of the solid component of periodontoid masses linked to atlantoaxial instability has not yet been reported in literature. To the best of our knowledge, this is the first case of C1–C2 instability with periodontoid pseudotumor leading to subarachnoid hemorrhage. |
| format | Article |
| id | doaj-art-5e8dc05762bd4681a036ccbef37e3a13 |
| institution | Kabale University |
| issn | 2277-954X 2277-9167 |
| language | English |
| publishDate | 2015-12-01 |
| publisher | Thieme Medical and Scientific Publishers Pvt. Ltd. |
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| series | Indian Journal of Neurosurgery |
| spelling | doaj-art-5e8dc05762bd4681a036ccbef37e3a132025-08-20T03:34:32ZengThieme Medical and Scientific Publishers Pvt. Ltd.Indian Journal of Neurosurgery2277-954X2277-91672015-12-01040318018410.1055/s-0035-1568998C1–C2 Instability Associated with Periodontoid Inflammatory Tissue Leading to Subarachnoid Hemorrhage: A Case Report and Review of the LiteratureRiccardo Draghi0Lorenzo Giammattei1Pietro Scarone2Giordano Lanfranchi3Angelica Bava4Mauro Pluderi5Department of Neurosurgery, University of Milan, Milan, ItalyDepartment of Neurosurgery, University of Milan, Milan, ItalyDepartment of Neurosurgery, Lugano Regional Hospital, Lugano, SwitzerlandDepartment of Neurosurgery, University of Milan, Milan, ItalyIstituti Clinici di Perfezionamento, Orthopaedic Trauma Center, Rehabilitation Center for Spinal Cord Injuries, Milan, ItalyDepartment of Neurosurgery, Fondazione IRCCS Ca' Granda–Ospedale Maggiore Policlinico, Milan, ItalyAbstract The authors present a case of atlantoaxial instability associated with C1–C2 inflammatory tissue leading to subarachnoid hemorrhage. A 65-year-old male patient arrived in June 2011 to the emergency unit for cervical pain and fever. Imaging studies documented periodontoid pseudotumor at C1–C2 level. Infective disease was suspected; the patient was therefore hospitalized and treated with antibiotics. Subsequent computed tomographic (CT) scans revealed C1–C2 instability. In August, the patient showed acute neurological deterioration and coma. Urgent brain CT revealed a hemorrhagic lesion which caused compression on the medulla oblongata, subarachnoid hemorrhage, and ventricular dilatation. An external ventricular drainage was positioned. Angio-CT and angiography did not show any vascular abnormalities. Cervical magnetic resonance imaging documented a solid tissue lesion between the atlas arch and axis. The lesion was associated with an epidural and subdural hematoma, exerting compression on brainstem. The patient underwent posterior decompression and C1–C2 fusion according to Harms technique in October, with significant clinical improvement. The authors present a case of atlantoaxial instability associated with a periodontoid pseudotumor at C1–C2 level determining dural sac compression. The patient showed an acute neurological deterioration caused by bleeding of the solid component of the cervical lesion. Hemorrhage of the solid component of periodontoid masses linked to atlantoaxial instability has not yet been reported in literature. To the best of our knowledge, this is the first case of C1–C2 instability with periodontoid pseudotumor leading to subarachnoid hemorrhage.http://www.thieme-connect.de/DOI/DOI?10.1055/s-0035-1568998periodontoid pseudotumoratlantoaxial instabilitysubarachnoid hemorrhage |
| spellingShingle | Riccardo Draghi Lorenzo Giammattei Pietro Scarone Giordano Lanfranchi Angelica Bava Mauro Pluderi C1–C2 Instability Associated with Periodontoid Inflammatory Tissue Leading to Subarachnoid Hemorrhage: A Case Report and Review of the Literature Indian Journal of Neurosurgery periodontoid pseudotumor atlantoaxial instability subarachnoid hemorrhage |
| title | C1–C2 Instability Associated with Periodontoid Inflammatory Tissue Leading to Subarachnoid Hemorrhage: A Case Report and Review of the Literature |
| title_full | C1–C2 Instability Associated with Periodontoid Inflammatory Tissue Leading to Subarachnoid Hemorrhage: A Case Report and Review of the Literature |
| title_fullStr | C1–C2 Instability Associated with Periodontoid Inflammatory Tissue Leading to Subarachnoid Hemorrhage: A Case Report and Review of the Literature |
| title_full_unstemmed | C1–C2 Instability Associated with Periodontoid Inflammatory Tissue Leading to Subarachnoid Hemorrhage: A Case Report and Review of the Literature |
| title_short | C1–C2 Instability Associated with Periodontoid Inflammatory Tissue Leading to Subarachnoid Hemorrhage: A Case Report and Review of the Literature |
| title_sort | c1 c2 instability associated with periodontoid inflammatory tissue leading to subarachnoid hemorrhage a case report and review of the literature |
| topic | periodontoid pseudotumor atlantoaxial instability subarachnoid hemorrhage |
| url | http://www.thieme-connect.de/DOI/DOI?10.1055/s-0035-1568998 |
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