Traumatische extraparenchymale Blutung der hinteren Schädelgrube als Warnsymptom einer atlantoaxialen Instabilität

Abstract

Introduction: We report on five patients following cranio-cerebral trauma. In all cases, cranial computer tomography (CT) scan showed evidence of extra-cerebral bleeding of the posterior cranial fossa (PCF) in a pattern unrelated to the other intra-cranial lesion. Patients: The patients were children or young patients averaging 14.8 years. While three of the cases showed epidural bleeding in the area of the clivus or the posterior cranial fossa, one patient showed sub-arachnoid bleeding around the cerebellum, the other in the 4th ventricle. Hemorrhagia was a first sign pointing to a lesion in the upper cervical spine (CS) and suggested the need for further diagnostic imaging. In five of these patients a lesion of the ligament with C1/C2 instability was diagnosed as an underlying cause of hemorrhage, with additional osseous lesion of the CS only present in one case. Therapy: Surgical treatment was necessary in all four cases with proven instability, while the fifth case was treated conservatively. Results: All patients undergoing surgery showed clinical improvement or continued to lack neurological symptoms. Following a median 5 years and 8 months’ follow-up, a stable situation with good functionality was proved in all patients. Conclusion: Traumatic extra-cerebral bleeding of PCF as evidenced in imaging scans must be interpreted as a warning sign of ligament lesion of the upper CS necessitating exact functional screening of the cranio-cervical transition and the upper CS.