Pediatric emergency medicine trisk 3621 3621

FIGURE 112.33 Rotary subluxation of C1 and C2. A: Grossly normal lateral neck radiograph
in an 8-year-old child with rotary subluxation. B: Grossly normal open-mouth (odontoid)
radiograph in an 8-year-old child with rotary subluxation. C: Computed tomographic (CT) scan
demonstrating marked rotary subluxation of C1 clockwise around dens. Actual measurement
was 22 degrees of rotation. D–G: CT evidence of fixed rotary subluxation in a 6-year-old child.
D: Lateral radiograph demonstrating mild increased distance of predental space. E: Axial CT
scan demonstrating asymmetry between right and left sides and increased distance between dens
and patient’s left side of C1 (star noted on E–G ) (asymmetry between right and left sides). F:
Axial CT scan with patient’s head turned to the right, demonstrating asymmetry between the
dens and ring of C1. G: Axial CT scan with patient’s head turned to the left, demonstrating fixed
asymmetry between the dens and the ring of C1.

Spinal Cord Syndromes
Several specific spinal cord syndromes may be encountered in the ED ( Fig.
112.34 ). A spinal cord concussion (transient traumatic paresis or paralysis)
involves neurologic symptoms that completely resolve over a short period. This
condition can occur with or without associated fracture or dislocation. A complete
cord transection (either mechanical or physiologic) results in immediate and
permanent loss of all neurologic functions distal to that level ( Fig. 112.34 ). The