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CC BY-NC-ND 4.0 · Arquivos Brasileiros de Neurocirurgia: Brazilian Neurosurgery 2021; 40(01): 101-106
DOI: 10.1055/s-0040-1719007
Case Report | Relato de Caso

Traumatic Atlantoaxial Rotatory Subluxation in Adult: Case Report

Subluxação rotatória atlantoaxial traumática em adulto: Relato de caso
Rafaela Campos Alcântara 
1   Universidade Federal de Alagoas, Arapiraca, AL, Brazil
,
Jacks Alan Tenório de Souza 
2   Hospital de Emergência Dr. Daniel Houly, Arapiraca, AL, Brazil
,
Andrei Fernandes Joaquim 
3   Department of Neurology, Universidade de Campinas (UNICAMP), Campinas, SP, Brazil
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Abstract

Traumatic atlantoaxial rotatory subluxation (AARS) is generally found in pediatric patients, rarely found in adults, being a life-threatening condition especially when early diagnosis is not possible, which can lead to severe late neurological deficits. We describe a 38-year-old patient, victim of physical aggression caused by strangulation attempt who developed AARS, an uncommon traumatic cause. During the hospital care, the early diagnosis allowed us to institute a conservative treatment, which made the case uncommon, since most of the time surgical treatment is imperative. With the patient awake and under analgesia, a closed reduction was performed that promoted immediate pain relief, followed by a prescription of wearing a Philadelphia-type collar for 8 weeks. During the follow-up, cervical spine radiographies demonstrated no subluxation after removing the cervical collar. The patient was asymptomatic after 6 months of treatment. This case supports the importance of nonoperative management of AARS in selected cases.

Resumo

A subluxação rotatória atlantoaxial (SRAA) é geralmente encontrada em pacientes pediátricos, sendo em adultos uma condição muito rara, ameaçadora à vida e que, quando não diagnosticada precocemente, pode levar a grave deterioração neurológica tardia. Descrevemos um caso de uma paciente de 38 anos, vítima de agressão física por tentativa de estrangulamento que desenvolveu uma SRAA, uma causa traumática incomum. No atendimento hospitalar, o diagnóstico precoce permitiu que o tratamento conservador fosse instituído, o que tornou o caso incomum, uma vez que, na maioria das vezes, o tratamento cirúrgico é imperativo. Com a paciente acordada e sob analgesia, foi realizada uma redução fechada que promoveu alívio imediato da dor, com prescrição de uso de colar tipo Philadelphia por 8 semanas. No seguimento, radiografias da coluna cervical não evidenciaram luxação após a retirada do colar, com manutenção da estabilidade. Em acompanhamento ambulatorial, a paciente permaneceu sem sintomas após 6 meses de seguimento. Este caso demonstra o sucesso do tratamento não cirúrgico em SRAA em adultos, que pode ser empregado em casos selecionados.

Keywords

atlantoaxial rotatory subluxation - trauma - adult

Palavras-Chave

subluxação rotatória atlantoaxial - trauma - adulto

Patient's Consent

The patient has agreed to the disclosure of her case, as well as of the exam images presented in this document, through a written agreement term.




Publication History

Received: 25 May 2020

Accepted: 04 September 2020

Article published online:
26 November 2020

© 2020. Sociedade Brasileira de Neurocirurgia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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