Jefferson's Fracture

Normal alignment of lateral masses and superior facets of C2

Displaced lateral masses on C1 with respect to the superior facets on C2

This image shows a fracture to the anterior arch of C1

The top image shows the offset of both the right and left lateral masses of C1 relative to C2

The bottom image shows the classsic Jefferson fracture where both anterior and posterior arches of C1 are fractured on both the right and left sides.

What kind of fracture is this?

This fracture involves cervical vertebra number one or the Altas. This fracture classically presents itself as having right and left side breaks on both the anterior and posterior arches of C1 for a total of 4 fractures of C1, but can present with varied numbers of breaks on either side of the anterior and posterior arches depending on how the force is exerted to the head. This type of fracture is also called a burst fracture. This type of fracture is an axial compression fracture where the force of the trauma or injury initiates from a superior or anterior aspect of the skull and then transmits to the cervical spine causing damage. The damage occurs when the downward force compressed C1 onto C2. Some of the more common examples of how these fractures occur are from diving into a shallow pool of water where the head strikes the bottom of the pool, motorcycle accidents where the head strikes the windshield causeing hyperextension and compression, and also falling down onto the head at a decent height.

What kinds of symptoms to patients present with this type of fracture?

-upper neck pain

-there is usually no neurological symptoms displayed initially but if not treated this can cause severe neurological problems if fracture is not stablized

Diagnosis?

-plain film xrays initially taken (open mouth is usually the best image to show the bilateral offset of C1 onto C2)

-CT (Demonstrates the number of fractures and their locations and the degree of displacement of bone fragments)

Treatment?

-Depends on the severity and the stability of the fractures

-The stability of the injury depends on how intact the ligaments are between the vertebra and will determine if surgery is needed to stabilize the fractures

References

www.learningradiology.com/archives06/COW%20188-Jeffersons%20FX/jeffersonsfxcorrect.htm

www.gentili.net/image1.asp?ID=11&imgid=JeffersonCT2.jpg&fx=Jefferson+Fracture

Bow Hunter's Syndrome

What is this?

Bow Hunter's syndrome or commonly called Bow Hunter's Stroke is an ischemic stroke that is caused by the constriction of the vertebral arteries which provide blood flow to the posterior part of the brain.

How does this happen?

Bow Hunter's syndrome can occur by either voluntary or forced rotational movements of the head. As the head is rotated right or left these vessels can become constricted. As the head is rotated to the right, the left vertebral artery is affected as is the right vessel is constricted when the head is rotated to the left. The constriction can occur due to an abnormal congenital deformity of the cervical verebrae. The level at which this commonly occurs is at C1-C2. With this constriction comes occlusions or even a complete stenosis of the artery leading to a loss of blood flow to that side of the brain. Complications due to this affliction can range from TIA like symptoms to a full blown CVA.

Signs and Symptoms?

-Dizzyness

-Nystagmus (involutary eye movements)

-Nausea/Vomiting

-Hemiparesis (weakness or partial paralysis of one side of the body)

-Sensory Changes

-Swallowing difficulties

-Loss of Consciousness

Diagnosis?

-MRI imaging of the brain or cervical spine

-MRA

-Angiogram

Treatment?

-Surgical Fusion of the vertebrae

-Vertebral Artery Decompression

-Neck Brace

References

www.thebarrow.org/Education/Barrow_Quarterly/Vol._17_No._2_2001/047231

www.riversideonline.com/health_reference/Nervous-System/AN00291.cfm

Goiter

What is a Goiter?

A Goiter is an enlargement of any gland that is producing too much (hyperthyroidism), too little (hypothyroidism), or just enough hormone (euthyroidism). Typically, when speaking of a goiter, we often refer to the thyroid gland. When a goiter has been noted, it basically means that there is something going on with the gland to make it grow bigger than normal.

Causes?

The number one cause of goiters worldwide today is iron deficency. This is rarely seen today in the U.S. simply for the fact that the salt we intake has iodine added to it. The Morton salt company was the first to add iodine to their salt in 1924. Without iodine the thyroid gland is unable to produce the proper amount of hormone. The pituitary gland in the brain then senses this difficency and sends the thyroid a signal to produce TSH (thyroid stimulating hormone) which is basically telling the thyroid to produce more thyroid hormone. This is what causes the enlargment or abnormal growth of the thyroid gland.

Another cause of a goiter more commonly seen in the U.S. today is called Hashimoto's thyroiditis. This is an autoimune disease where one's own body basically attacks itself or the thyroid gland which causes a difficency in the production of thyroid hormone. Again, the pituitary gland senses this abnormality and tells the thyroid to produce more TSH in order to produce more thyroid hormone causing the gland to enlarge.

Diagnosis?

The diagnoisis of a goiter is usually found on physical examination. Once found it is important to find the cause. Initially a thyroid functioning test will be performed to determine if the thyroid gland is overactive or underactive in producing hormone. Depending on the activity of the thyroid other tests are performed to determine the type of goiter the patient has. Tests like radioactive iodine scans and thyroid ultrasounds are performed to determine the causes of goiters.

Treatment?

Treatment is specific to the type of goiter one has. If the cause is due to an iron deficency, then the patient would be given iron supplements orally. Iron supplements will reduce the size of the goiter but they will not completely resolve the goiter.

If the goiter is due to Hashimoto's thyroiditis or an autoimmune issue the patient would receive a hormone pill that would be taken daily to regulate the thyroid hormone to a normal level. This treatment would most likely cause the goiter to reduce in size, but again would probably not reduce it completely. Thyroid hormone treatment will keep the goiter from becoming larger in size.

References

www.thyroid.org/patients/patient_brochures/goiter.html

www.mortonsalt.com/faqs/food_salt_faq.html#q5