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academies
September 20-22, 2017 | Toronto, Canada
10
TH
AMERICAN PEDIATRICS HEALTHCARE &
PEDIATRIC INFECTIOUS DISEASES CONGRESS
Pediatric Healthcare & Pediatric Infections 2017
B
asilar impression is a congenital or acquired cranio-cervical junction
abnormality where the tip of the odontoid process projects above
the foramen magnum, seen as upward displacement of the dens due to
softening of the bones at the skull base. The resultant foramen magnum
stenosis and compression of the medulla oblongata or spinal cord can
cause neurological symptoms, obstructive hydrocephalus, syringomyelia
or even death. It may be acquired due to rheumatoid arthritis, Paget’s
disease, hyperparathyroidism and rickets. To the best of our knowledge,
cases of tuberculosis causing basilar impression are regarded rare. This
case highlights the importance of ruling in of tuberculosis in endemic
areas, especially in young patients with a chronic history of neck pain and
features of tuberculosis. A 17 years old female presented with progressively
increasing right neck mass with fistula since a year and worsening neck pain
since four months. It was associated with restriction of neck movements,
low grade fever, anorexia and weight loss followed by gradually progressive
right sided hemiparesis since three months before presentation.
Neurological examination revealed right sided hemiparesis without cranial
nerve palsy. Contrast CT scan of the cranium and cervical spine revealed
osteolytic lesions of the C1 and C2 bodies and clivus, vertical displacement
of dens above the foramen magnum with resultant mass effect at the
cervicomedullary junction, perivertebral and epidural abscess at C1-C5
with consequent spinal cord compression and cervical lymphadenopathy.
There was evidence of basilar impression; the dens appearing 1 cm above
the Chamberlain line. A diagnosis of craniovertebral junction for Pott’s
disease was made. The patient started antitubercular treatment. She
showed significant improvement in her neurological deficit during follow-
up. As a rare case of craniovertebral junction Pott’s disease causing basilar
impression, the timely suspicion and subsequent management with
antitubercular treatment played a vital role in preventing further morbidity
and mortality.
Speaker Biography
Bista N has completed her MBBS at the age of 26 years fromManipal College of Medical
Sciences, Kathmandu University, Nepal on Novermber 2015. She is currently pursuing
her residency training in radiology at the Bicol Medical Center, Naga City, Philippines.
She is to share her interesting cases and looks forward to being actively involved in
publication and further enhancing her academics and training.
e:
bistaneha@hotmail.comA case report on a rare case of basilar impression caused by tuberculous infection
Neha Bista, Collao M
and
Ghimire P
Bicol Medical Center, Philippines