Congenital irreducible atlantoaxial dislocation associated with cervical intramedullary astrocytoma causing progressive spastic quadriparesis
| Autor: | Manoj Jain, Sanjay Behari, Awadesh K. Jaiswal, Anooj Chatley |
|---|---|
| Rok vydání: | 2009 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Radiography Joint Dislocations Astrocytoma Quadriplegia Neurosurgical Procedures law.invention Intramedullary rod Myelopathy law medicine Humans Spasticity Spinal Neoplasms medicine.diagnostic_test Atlanto-axial joint business.industry Laminectomy Magnetic resonance imaging Middle Aged medicine.disease Magnetic Resonance Imaging Surgery medicine.anatomical_structure Neurology Atlanto-Axial Joint Female Neurology (clinical) medicine.symptom business |
| Zdroj: | Neurology India. 56(4) |
| ISSN: | 0028-3886 |
| Popis: | Simultaneous presence of congenital irreducible atlantoaxial dislocation (AAD) and cervical intramedullary astrocytoma has not been previously described and may cause disabling myelopathy. This 55-year-old lady presented with suboccipital pain, spastic quadriparesis, Lhermitte's phenomenon and sphincteric disturbances. Lateral radiographs and magnetic resonance imaging showed irreducible AAD, occipitalized atlas, C2-3 fusion, and,an intramedullary tumor from C2-5 level iso-to-hypointense, non-enhancing, except in a small segment in the dorsal C2 level. A suboccipital craniectomy with C2-5 laminectomy revealed a greyish-white tenacious tumor. The tumor was decompressed using a C2-5 midline myelotomy and duroplasty. An occipitocervical lateral mass fixation was performed. Histopathology revealed a low-grade astrocytoma. At three-month follow-up, her spasticity had decreased and quadriparesis and sphincteric disturbances were persisting. Postoperative lateral radiographs and intrathecal contrast CT scan showed a stable occipitocervical construct. Thus, the suboccipital craniectomy and laminectomy with midline myelotomy and duroplasty facilitated space for progressively expanding intramedullary astrocytoma with irreducible AAD; the lateral mass fixation provided stability at the craniovertebral junction. |
| Databáze: | OpenAIRE |
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