AGENESIS OF THE POSTERIOR ARCH OF THE ATLAS: AN INCIDENTAL FINDING IN A POLYTRAUMATIZED PATIENT

ABSTRACT The first cervical vertebra is subject to numerous anatomical variations. One of these is posterior arch agenesis, which is classified into five distinct morphological types. Together, all types of posterior arch agenesis comprise only 4% of atlas variations. Furthermore, complete agenesis of the posterior arch associated with the presence of the posterior tubercle is rare. This work reports a case of posterior arch agenesis with the presence of the posterior tubercle in a 33 year-old male victim of a motor vehicle collision. Despite being asymptomatic, this anatomical variation can present with headaches and neck pain. It is mostly found as an incidental finding in imaging studies performed by the emergency team and, as a result, it is often misdiagnosed as a C1 fracture. Knowledge of the variations relating to the first cervical vertebra is therefore essential to avoid delays in diagnosis and treatment of polytraumatized patients. Level of evidence V; Case report.

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Post-trauma transmesocolic hernia: a case report

Journal of Surgical Case Reports ◽

10.1093/jscr/rjaa417 ◽

2020 ◽

Vol 2020 (10) ◽

Author(s):

Doaa Hussin Salam ◽

Mohannad Al-Tarakji ◽

Abubaker Ibrahim Alaieb ◽

Rajvir Singh ◽

Ayman El-Menyar ◽

...

Keyword(s):

Bowel Obstruction ◽

Motor Vehicle ◽

Epigastric Pain ◽

Abdominal Distension ◽

Emergency Laparotomy ◽

Trauma Patients ◽

Male Victim ◽

Internal Hernias ◽

Vehicle Collision ◽

Clinical Consequences

Abstract The prevalence of transmesocolic hernias, a subtype of internal hernias (IHs), is generally low. Its clinical consequences, including strangulation, ischemia and even death, however, necessitate awareness. IHs are classified as congenital or acquired as resulting from surgery, trauma or intraperitoneal inflammation. This is a case of a 37-year-old male victim of a motor vehicle collision 1 month prior to the index admission. The trauma-related injuries were managed conservatively and then discharged home. The patient was re-admitted with a 2-day history of epigastric pain, vomiting and abdominal distension. A diagnosis of small bowel obstruction due to a transmesocolic hernia was made on CT and emergency laparotomy performed. The post-operative course was unremarkable. It is vital to consider transmesocolic hernias in trauma patients presenting with a picture of bowel obstruction even in the absence of prior surgery.

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Morphometric study of the posterior arch of atlas vertebra in the Serbian population

Medicinski pregled ◽

10.2298/mpns1808250p ◽

2018 ◽

Vol 71 (7-8) ◽

pp. 250-255

Author(s):

Radmila Peric ◽

Bojana Krstonosic ◽

Ivana Starcevic

Keyword(s):

Vertebral Artery ◽

Cervical Vertebra ◽

Anatomical Variations ◽

Morphometric Study ◽

Posterior Arch ◽

Class Iii ◽

Maximum Width ◽

Morphological Variations ◽

Significant Difference ◽

Superior Surface

Introduction. Groove for the vertebral artery and the suboccipital nerve, is located on the superior surface of the posterior arch of the first cervical vertebra (the atlas). Presence of bony variations may transform the groove into incomplete/complete canal, causing compression of its structures and consequently symptoms of vertebro-basilar insufficiency. The aim of the present study was to determine the incidence and extent of morphological variations of the posterior arch of the atlas vertebra. Material and Methods. The investigation was conducted on 41 atlas vertebrae, part of the Osteological Collection of the Department of Anatomy of the Faculty of Medicine in Novi Sad and the Faculty of Medicine in Nis. According to the shape of the posterior arch, the atlas vertebrae were classified into three classes. The measurements of maximum width and height diameters of the incomplete/complete canal for the vertebral artery were performed. All the measurements were done using open source software for image analysis, Image J. Results. The results of the study showed that in our sample of atlases the most common class was class I (78.05%), and class III the least frequent (7.32%). There was no statistically significant difference in the observed measurements of the atlas anatomical variations between the right and left side. Conclusion. Morphometric analysis of the superior surface of the posterior arch of the atlas vertebra has shown the existence of variations and their importance has been discussed.

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Posterior midline cleft of the atlas – a crucial anatomical variation in vertebral fractures

Iberoamerican Journal of Medicine ◽

10.53986/ibjm.2021.0045 ◽

2021 ◽

Vol 3 (3) ◽

pp. 284-287

Author(s):

Serghei Covantev ◽

◽

Rasul Uzdenov ◽

Kseniya Zabudskaya ◽

Olga Belic ◽

...

Keyword(s):

Gonadal Dysgenesis ◽

Anatomical Variation ◽

Cervical Vertebra ◽

Chronic Neck Pain ◽

Clinical Implications ◽

Posterior Arch ◽

Cervical Vertebra Axis ◽

Chiari Malformations ◽

Midline Cleft ◽

Posterior Midline

The anatomy of the first vertebra, namely atlas, has significant clinical implications. Atlas is situated between the occipital bone and the second cervical vertebra (axis) and is one of the main points of head movement. Most congenital anomalies of the vertebra are diagnosed incidentally during imaging investigations and can be associated with cervical spine anomalies. The neurological symptoms may include weakness in the four limbs, acute neurologic deficits such as transient quadriparesis, paraparesis, Lhermitte's sign, chronic neck pain, and headache. This anomaly is also commonly seen in gonadal dysgenesis, Klippel-Feil syndrome, Arnold-Chiari malformations, and Turner and Down syndrome. Unlike other variations, which arise due to disturbances of ossification posterior midline clefts of the atlas, are different since they are a developmental failure of chondrogenesis. We therefore present an anatomical case and analysis of the literature about posterior arch clefts of atlas.

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A Differential Diagnosis of Haematuria following a Motor Vehicle Collision: Nutcracker Syndrome

Case Reports in Surgery ◽

10.1155/2015/749182 ◽

2015 ◽

Vol 2015 ◽

pp. 1-3 ◽

Cited By ~ 1

Author(s):

Gary Sharp ◽

Derek Glenn

Keyword(s):

Motor Vehicle ◽

Incidental Finding ◽

Left Renal Vein ◽

Young Female ◽

Motor Vehicle Collision ◽

Refractory Anaemia ◽

Nutcracker Phenomenon ◽

Vehicle Collision ◽

Left Flank Pain ◽

Pelvic Congestion

A young female presented to the emergency department following a motor vehicle collision. She complained of left flank pain and was found to have haematuria. After investigation no trauma related injuries were identified. However, an incidental finding of nutcracker phenomenon/syndrome was made. Nutcracker phenomenon is a rare cause of haematuria resulting from nontraumatic compression of the left renal vein between the superior mesenteric artery and the aorta. It affects females more than males and its presentation can range from asymptomatic to debilitating haematuria, pelvic congestion in females, varicosities in males, and pain. No validated diagnostic criteria exist and treatment is usually surgical in those with debilitating symptoms or refractory anaemia.

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Incidental neuroendocrine tumor of a complete subserosal appendix: an unusual presentation of a rare anatomical variation. A case report and review of literature

BMC Surgery ◽

10.1186/s12893-021-01429-3 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Stalin Isaías Cañizares Quisiguiña ◽

Lucía Vanessa Guamán Maldonado ◽

Iván Marcelo Hidalgo Jaramillo ◽

Tatiana Paola Borja Herrera ◽

Cecilia de los Ángeles Carrión Guzmán

Keyword(s):

Incidental Finding ◽

Case Reports ◽

Anatomical Variation ◽

Treatment Options ◽

Anatomical Variations ◽

Appropriate Treatment ◽

Final Treatment ◽

Therapeutic Decisions ◽

Long Term Prognosis ◽

Clinical Pictures

Abstract Background Appendix’ anatomical variations are a rare occurrence which can mislead diagnosis and delay appropriate treatment. Case presentation We present a 9-year-old female patient that came with a clinical picture compatible with acute appendicitis. However, a cecal mass was identified instead of an inflamed appendix during surgery. Therapeutic decisions were extremely challenging due to clinical deterioration and an uncertain etiology. Only the histopathology report revealed the presence of a complete subserosal appendix which was responsible for the entire symptomatology. Here, we review all case reports regarding intramural, intracecal or subserosal appendixes. A discussion of the general approach to this specific case and the importance of consensual diagnostic criteria for these specimens are also presented. At last, an incidental finding is exposed and final treatment options are discussed given the overall presentation. Conclusions Considering these variants would guide physicians towards a more accurate approach to similar clinical pictures and hence an improved long-term prognosis.

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Case Exercise: Biomechanics in Rearend Motor Vehicle Collisions

Guides Newsletter ◽

10.1001/amaguidesnewsletters.2007.mayjun02 ◽

2007 ◽

Vol 12 (3) ◽

pp. 4-7

Author(s):

Charles N. Brooks ◽

Christopher R. Brigham

Keyword(s):

Motor Vehicle ◽

Body Position ◽

Motor Vehicle Collisions ◽

Time Curve ◽

Vehicle Collisions ◽

Need For Treatment ◽

Multiple Factors ◽

Bodily Injury ◽

Vehicle Collision ◽

Physical Findings

Abstract Multiple factors determine the likelihood, type, and severity of bodily injury following a motor vehicle collision and, in turn, influence the need for treatment, extent of disability, and likelihood of permanent impairment. Among the most important factors is the change in velocity due to an impact (Δv). Other factors include the individual's strength and elasticity, body position at the time of impact, awareness of the impending impact (ie, opportunity to brace, guard, or contract muscles before an impact), and effects of braking. Because Δv is the area under the acceleration vs time curve, it combines force and duration and is a useful way to quantify impact severity. The article includes a table showing the results of a literature review that concluded, “the consensus of human subject research conducted to date is that a single exposure to a rear-end impact with a Δv of 5 mph or less is unlikely to result in injury” in most healthy, restrained occupants. Because velocity incorporates direction as well as speed, a vehicular occupant is less likely to be injured in a rear impact than when struck from the side. Evaluators must consider multiple factors, including the occupant's pre-existing physical and psychosocial status, the mechanism and magnitude of the collision, and a variety of biomechanical variables. Recommendations based solely on patient history and physical findings (and, perhaps, imaging studies) may be ill-informed.

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Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽

10.1024/0301-1526/a000138 ◽

2011 ◽

Vol 40 (5) ◽

pp. 404-407

Author(s):

Maras ◽

Tzormpatzoglou ◽

Papas ◽

Papanas ◽

Kotsikoris ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Local Anaesthesia ◽

Anatomical Variation ◽

Anatomical Variations ◽

Circle Of Willis ◽

Variable Degree ◽

Operative Complications ◽

The Right ◽

Ica Stenosis ◽

Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

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