Unilateral avulsion fracture of the transverse atlantal ligament: successful treatment in a rigid cervical collar

A 34-year-old male sustained a unilateral avulsion fracture through the origin of the transverse atlantal ligament following a road traffic accident. This was successfully treated in a rigid neck collar for 8 weeks. Injuries to the transverse atlantal ligament are often associated with significant bony injury and atlanto-axial instability. Isolated injuries to the transverse ligament are extremely rare and the present case suggests that a trial of conservative management may be worth pursuing. Intradural cervical lipomas with intracranial extension are very rare. There have been 12 previously reported cases. We report an 18-year-old female who presented with quadraparesis and incontinence, and review the previously published literature. Intradural lipomas with intracranial extension occur in younger patients when compared with those without intracranial extension. Roughly half of high cervical lipomas have intracranial extension. This results in a more complicated course of surgical management and a worse prognosis. While the relatively older patients most commonly present with quadriplegia, in younger patients there may be a more variable presentation. Almost half the patients had symptoms ascribable to the intracranial component. In all patients, no more than subtotal resection and decompression was achieved using duroplasty if necessary. Only five patients showed functional recovery. We propose a management strategy for this condition. We present the case of a young male with severe head injury, cervico-thoracic fractures, and an initially unrecognized brainstem infarct due to unilateral dissection of vertebral artery, who made an unusually excellent recovery. This report stresses the importance of prompt clinico-imaging diagnosis and prophylactic anticoagulant treatment in such cases. We present a patient with a recurrent glioblastoma and abnormalities of the corpus callosum seen on diffusion tensor MRI that were not seen on conventional imaging. These abnormalities preceded the development of the tumour. We describe the technique of diffusion tissue signatures to assess tissue infiltration by tumours compared with values from normal volunteers.