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A Blast of Mistakes: Undiagnosed Cervical Spondylolisthesis Following a Bomb Explosion

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ABSTRACT

Patient: male, 20"/> MedlinePlus

CT scan of the cranium shows a linear fracture of the left occipital condyle without distortion or displacement of the bone.
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f1-amjcaserep-18-320: CT scan of the cranium shows a linear fracture of the left occipital condyle without distortion or displacement of the bone.

Mentions: A 20-year-old man was wounded in a bomb explosion in Africa. Seven days after the traumatic event, when his condition was considered stable, he was transferred by airplane from Africa to Italy and was immediately admitted to a major hospital in Rome. There, the patient, who was also riddled with shrapnel in various areas of the body, was diagnosed and treated for the following traumatic lesions: right side pneumothorax, fractures to the sternum, to the left scapula, to the left wrist, and to the left side of the jaw bone. The patient underwent a CT scan of the cranium and cervical spine, which showed only a linear fracture of the left occipital condyle, without distortion or displacement of the bone (Figure 1). The cervical vertebrae appeared normal (Figure 2) and untouched by the trauma. The only noteworthy aspect of the spine was the loss of the normal lordosis. In truth, the CT scan already showed some signs of instability: the interspinous space between C5 and C6 appeared increased compared to the other interspinous spaces. Moreover, in the parasagittal and axial images, the distance between the articular facets C5–C6 was excessive, but these signs were not detected by the medical team at the hospital. The neurological examination did not show any abnormalities. It was deemed no longer necessary for the patient to wear the neck brace that had been put on him from the very beginning. A week after hospital admission in Italy, the patient began complaining more and more persistently of pronounced cervical pain, but considering the normal CT scan findings, the absence of any neurological impairments, and the fact that the patient walked well, the problem was ascribed to muscular tension due to cervical “whiplash” and posttraumatic stress disorder. In truth, when a chest x-ray was carried out 10 days after the patient was admitted to hospital, a preliminary scan of the whole body was also performed, which showed grade 1 C5–C6 spondylolisthesis (Figure 3), but no one noticed.


A Blast of Mistakes: Undiagnosed Cervical Spondylolisthesis Following a Bomb Explosion
CT scan of the cranium shows a linear fracture of the left occipital condyle without distortion or displacement of the bone.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC5382837&req=5

f1-amjcaserep-18-320: CT scan of the cranium shows a linear fracture of the left occipital condyle without distortion or displacement of the bone.
Mentions: A 20-year-old man was wounded in a bomb explosion in Africa. Seven days after the traumatic event, when his condition was considered stable, he was transferred by airplane from Africa to Italy and was immediately admitted to a major hospital in Rome. There, the patient, who was also riddled with shrapnel in various areas of the body, was diagnosed and treated for the following traumatic lesions: right side pneumothorax, fractures to the sternum, to the left scapula, to the left wrist, and to the left side of the jaw bone. The patient underwent a CT scan of the cranium and cervical spine, which showed only a linear fracture of the left occipital condyle, without distortion or displacement of the bone (Figure 1). The cervical vertebrae appeared normal (Figure 2) and untouched by the trauma. The only noteworthy aspect of the spine was the loss of the normal lordosis. In truth, the CT scan already showed some signs of instability: the interspinous space between C5 and C6 appeared increased compared to the other interspinous spaces. Moreover, in the parasagittal and axial images, the distance between the articular facets C5–C6 was excessive, but these signs were not detected by the medical team at the hospital. The neurological examination did not show any abnormalities. It was deemed no longer necessary for the patient to wear the neck brace that had been put on him from the very beginning. A week after hospital admission in Italy, the patient began complaining more and more persistently of pronounced cervical pain, but considering the normal CT scan findings, the absence of any neurological impairments, and the fact that the patient walked well, the problem was ascribed to muscular tension due to cervical “whiplash” and posttraumatic stress disorder. In truth, when a chest x-ray was carried out 10 days after the patient was admitted to hospital, a preliminary scan of the whole body was also performed, which showed grade 1 C5–C6 spondylolisthesis (Figure 3), but no one noticed.

View Article: PubMed Central

ABSTRACT

Patient: male, 20"/> MedlinePlus