Type 2 odontoid fracture c2 vertebrae,imagenes de diabetes tipo 1,diabetes miracle scam,freestyle blood sugar strips quiz - How to DIY

There have been studies to examine the need for c-spine imaging in low risk patients. AP and open-mouth views of the odontoid may need to be taken later in the X-ray Department. Thoracolumbar x-rays should be performed on all patients with multiple injuries or an accident mechanism with sufficient force that thoracolumbar injury could occur. Restrict movement by means of firm collar, sandbags each side of the head and forehead tape.
Perform a full neurological examination and include sacral reflexes if evidence of cord injury. If there are neurological symptoms or signs (but no spinal cord injury), the x-rays are abnormal or the patient remains in significant pain, refer to the ED duty doctor (see clearing the cervical spine).
Correlate history & examination when deciding whether or not to x-ray patients with neck sprains.
Patients with stable fractures may be sent home with analgesia to rest but admit if unable to stand or lack of support at home.
The US National Acute Spinal Cord Injury Studies (NASCIS) have shown that the administration of Methylprednisolone within 8 hours of blunt spinal injury may improve neurological outcome.
Please contact your local neurosurgical service or national spinal unit (Mater Misericordiae) for advice.
Surgically remediable cord compression due to dislocation of a vertebral body or displaced bone fragment must be treated urgently (within 2 hours). Even stable injuries can be associated with significant cord compression and may benefit from decompression surgery.
Early decompression has also been advocated for incomplete lesions, especially if the motor signs progressive.
November 24, 2008This review is based on a presentation given by Adam Flanders and adapted for the Radiology Assistant by Robin Smithuis.
Approximately 3 % of patients who present to the emergency department as the result of a motor vehicle accident or fall have a major injury to the cervical spine.
Up to 17% of patients have a missed or delayed diagnosis of cervical spine injury, with a risk of permanent neurologic deficit after missed injury of 29%. One third of injuries occur at the level of C2, and one half of injuries occur at the level of C6 or C7. Unstable wedge fracture is an unstable flexion injury due to damage to both the anterior column (anterior wedge fracture) as the posterior column (interspinous ligament).
Jefferson fracture is a burst fracture of the ring of C1 with lateral displacement of both articular masses .
There is a strong correlation between the length of the spinal cord edema and the clinical outcome.
The most important factor however is whether there is hemorrhage, since hemorrhagic spinal cord injury has an extremely poor outcome. The chart on the left is showing the motor recovery rate for patients with edema alone (in blue) versus edema plus cord hemorrhage (in red).
Central spinal cord injury in a patient with a hyperextension injury and preexisting spondylosis and stenosis. Frequently found in elderly with underlying spondylosis or younger people with severe extension injury (figure).
Upper extremity deficit is greater than lower extremity deficit, because the lower extremity corticospinal tracts are located lateral in the cord. Presents with immediate paralysis, because the corticospinal tracts are located in the anterior aspect of the spinal cord.
Ipsilateral motor weakness and contralateral sensory deficit due to hemisection of the spinal cord. Brown-Sequard syndrome may result from rotational injury such as fracture-dislocation or from penetrating trauma such as stab wound. Hyperflexion sprain injuries are injuries to the soft tissues of the spine without fracture. On the left images of a patient who has been in a car accident and complained of neck pain.
Edema in the vertebrae of the lower C-spine and upper T-spine indicating bone bruise as a result of axial loading.


In this patient we can conclude that there was mild hyperflexion strain and we do not know if a special treatment is required, since these were isolated MR-findings without evidence of fracture or abnormal positioning. There is controversy regarding the meaning of soft tissue abnormalities detected only on MRI. In trauma centres up to 25% of all patients with neck injury have signal abnormalities on MR and the significance is indeterminate. She subsequently had a second fall the following morning, where after she had complete loss of motor and sensation.
On physical examination there was lower extremity paraparesis with some upper extremity weakness on the right.
There is high density material at the back of the disc space, which is very suggestive for a traumatic disc herniation. A epidural hematoma should be in the differential, but this finding was limited to just the area of the disc space, unlike a hematoma. The axial image shows the spinal cord injury and in addition to it there is absence of flow void in the right vertebral artery.
In conclusion we can say that this patient had no fracture, but a severe hyperflexion sprain with acute disc herniation, non-hemorrhagic spinal cord injury and vertebral thrombosis. This results in an anterior subluxation of the upper vertebral body of about 25% of the AP diameter of the body. MRI plays an important role in the diagnosis in order to see if there is disc extrusion leading to cord compression. Malalignment of the spinous processes as seen on the AP-view, which can only be produced by a rotatory injury. On the axial view the left facet joint is normal and the configuration has similarities with the hamburger. Spinal cord lesion, which can be described as contusion, edema or non-hemorrhagic spinal cord injury. Rupture of the disc with migration of disc material on the posterior side of C4 and even on the anterior side of C5. There is anterior dislocation of the articular masses with disruption of the posterior ligament complex, posterior longitudinal ligament, the disc and usually also the anterior longitudinal ligament. When the dislocation is complete, the dislocated vertebra is anteriorly displaced one-half of the AP diameter of the vertebral body. Because of its extensive soft tissue damage and dislocated facet joints, BID is unstable and is associated with a high incidence of cord damage. Near one of the facets there is a small fleck of bone, but there is no major fracture, so this is basically just a hyperflexion soft tissue injury. Notice on the axial image that the cord injury is located in the grey matter, which is more sensitive to damage. In order to regain normal alignment, progressive weights are used to lengthen the spine until reduction is achieved.
Notice, that with 60 pounds the facets start to move, but it finally takes about 110 pounds before the neck is reduced. Because someone is holding on to the neck while more weight is added, an actual 'clunk' can be felt in the neck indicating that reduction is achieved.
On the left another bilateral interfacetal dislocation with complete transsection of the cord. The larger posterior part of the vertebral body is displaced backward into the spinal canal.
On x-rays the facet joints and interspinous distances are usually widened and the disk space may be narrowed.
It is an unstable fracture associated with complete disruption of ligaments and anterior cord syndrome.
On the left images of a 21 year old male who sustained a diving injury, striking his head in a swimming pool. Some would just call this a severe hyperflexion injury, but this entity is better known as a 'flexion tear drop' fracture. The vertical orientation of the fractures of the bodies of C4 and C5 indicate that there was severe axial loading. In fact these vertebral bodies kind of 'exploded' with propulsion of a bone fragment anteriorly (teardrop) and the larger part posteriorly against the spinal cord.


Sof tissue injuries anteriorly and posteriorly with flavum and interspinous ligament rupture and CSF leakage. Notice that the lower cervical area is not visualised well and additional imaging is required. The tear drop fragment is displaced anteriorly and the larger part of the vertebral body is displaced posteriorly compressing the spinal cord. Also notice the posterior ligamentous injury as a result of the hyperflexion with rupture of the ligamentum flavum and CSF leakage. Classically it is an extension-fracture as the hangman puts the knot under the chin to produce maximal extension-force. Although considered an unstable fracture, it seldom is associated with spinal injury, since the anteroposterior diameter of the spinal canal is greatest at this level, and the fractured pedicles allow decompression.
When associated with unilateral or bilateral facet dislocation at the level of C2, this type of hangman's fracture is unstable and has a high rate of neurologic complications. She had cervical tenderness to palpation, but was alert and had no neurologic abnormalities on examination. In this case there was no neurologic deficit, because the spinal canal is widened at the level of the fracture. On the left images of a 90-year-old male who tripped and fell on his back and the back of his head. There is also some hyperdensity at the back of C5C6, which could be a herniated disc or just preexisting disc degeneration. In such a patient with spondylosis which has led to narrowing of the canal, a low velocity injury can lead to spinal cord injury. There is only injury to the central part of the cord and these patients have disproportioned weakness of their arms and normal strength in their legs. As with flexion teardrop fracture, extension teardrop fracture also manifests with a displaced anteroinferior bony fragment (6).
This fracture occurs when the anterior longitudinal ligament pulls a bony fragment away from the inferior aspect of the vertebra because of the sudden hyperextension.
The fragment is a true avulsion, in contrast to the flexion teardrop fracture in which the fragment is produced by compression. This type of fracture is commonly seen in diving accidents and tends to occur at lower cervical levels.
It also may be associated with the central cord syndrome due to buckling of the ligamenta flava into spinal canal during the hyperextension phase of injury. On the left images of a 70 year old female who fell down ten steps striking her head resulting in a subgaleal hematoma with possible loss of consciousness.
This fragment is a true avulsion, in contrast to the flexion teardrop fracture in which the fragment is produced by compression of the anterior vertebral aspect due to hyperflexion.
This illustration is the Cervical Vertebrae and its connection to the skull which protects the spinal cord. Higher velocity, fall from a height, vertebral tenderness and neurological symptoms (ASIA Form if neurological signs) are the more important indicators for x-ray. If all radiographs and neurology are normal and the patient can mobilize well, treat with NSAIDS and refer to GP (Please see clearing the cervical spine section). The more common stable injuries are confined to simple wedge or crush fractures of the vertebral bodies and fractures of the transverse or spinous processes.
A burst fracture is an unstable comminuted fracture of the vertebral body with posterior displacement of fragments which may impinge on the spinal cord. TheĀ atlas (C1) and axis (C2), are the vertebrae that allow the neck and headĀ more movement than all the vertebrae. Compression fractures are associated with fracture of the os calcis produced by falling from a height.
The Occipital joint allows the skull to move up and down, while the axial joint allows the upper neck to twist left and right.



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