SlideShare una empresa de Scribd logo
1 de 36
A CASE OF SHORT NECK PROF.S.TITO’S UNIT
Perumal a 45 yr old male admitted with  ,[object Object]
          c/o giddiness on getting up -1 week,[object Object]
No h/o diff in passing through narrow pathways No h/o sensory disturbancces h/o diff in walking in darkness,&face wash No h/o olfactory, visual disturbances No h/o motor and sensory abnormalities of face h/o change of voice -3months No h/o other cranial nerve disturbances No h/o bladder,bowel and other autonomic disturbances
PAST HISTORY;  No h/o DM,HT,TB                   h/0 trauma falling from height present treated as IP in hospital  2 months records not available at 2 yrs of age. Personal history;  occ.smoker,alcoholic Family history;     no h/o any relevant illness
GENERAL EXAMINATION Pt conscious,oriented,notanaemic not jaundiced,nocyanosis,no clubbing ,no gla. Height:neck ratio 19:1 Webbing of neck Low hair line sprengel’s anomaly Left hemiatrophy Restricted neck movts on side to side Prominent epiglottis on opening mouth Mirror movements-synkinesia Pulse 70/mt,BP102/66 mmhg
SHORT NECK LOW HAIRLINE
PROMINENT EPIGLOTTIS
LT.HEMIATROPHY
synkinesia
HMF-NORMAL Cranial nerves;1,2,3,4,,6,7-normal 		     5th nerve – lt side diminished cor reflex       dim. touch sensation with brisk jaw jerk 	8th nerve conductive deafness lt side		 9&10 nerves gag reflex diminished		 11th nerve normal			                     12th nerve normal
Motor system Superficial reflexes –abdominal and cremasteric reflex present
Spastic  gait
Sensory system Pain and temperarure-normal Joint position and vibration sense diminished in all four limbs incl.vertebral Romberg’s sign positive
CEREBELLUM No nystagmus Finger nose,figer-finger-nose defective Lt.side No Dysdiaadokinesia,slurring of speech present Heel-shin test positive-lt side Tandem walking-defective
INVESTIGATIONS
Basilar Angle
CHAMBERLAIN’S LINE ,[object Object]
BasillarinvaginationChamberlain`s line
MCGREGOR’S LINE (Basal line)- Joins hard palate to lowest point of occipital bone Tip of dens should not exceed 5 mm above this line Mcgregor`s  Line
Height Index Of Klaus HEIGHT INDEX OF KLAUS – dense to tuberculam line < 30 basillarinvagination
McRae’s LINE Joins anterior and posterior edges of foramen magnum: sagittal diameter of foramen magnum. (Avg – 35mm);dense below the line 	foramen stenosis McRae`s Line
Clivus Canal Line
MRI LS SPINE
DIAGNOSIS 			KLIPPEL FEIL SYNDROME
KLIPPEL FEIL SYNDROME Congenital fusion of cervical vertebrae Failure of normal segmentation of the cervical vertebrae/somite between 3rd and 8th weeks of fetal development (rather than a secondary fusion)  Maurice Klippel and Andre Feil – 1912 Incidence – 1 in 42,000 births ;    more in females Autosomal dominant inheritance – C2-C3 fusion.  Autosomal recessive – C5- C6 fusion
CLASSIFICATION Feil’s classification Type I – massive fusion of many cervical and upper thoracic vertebrae with synostosis Type II – fusion of only 1 or 2 vertebrae (with hemivertebrae , scoliosis,  occipitoatlantoid fusion) Type III – presence of lower thoracic and upper lumbar spine anomalies with I/II Type IV – sacral agenesis Samartzis’s classification (2006) To clarify prognosis Type I – single congenitally fused cervical segment Type II – multiple non-contiguous fused segments Type III – multiple contiguous fused segments
CLINICAL FEATURES Patients with upper cervical spine involvement tend to present at an earlier age than those whose with lower cervical spine involvement Rotational loss and lateral bending is usually more pronounced than loss of flexion and extension because latter movements take place mostly between occiput and atlas Scoliosis – some patients congenital due to involvement of thoracic spine , others scoliosis compensatory to cervical scoliosis
FEIL’S TRIAD Low posterior hair line Short neck Limitation of head and neck movements / decreased range of motion in cervical spine
CLINICAL FEATURES Webbing of soft tissues on each side of the neck (extending from mastoid process to acromion of shoulders)- ‘pterygiumcolli’ torticollis due to contracture of sternocleidomastoid muscle or bony abnormalities Facial asymmetry Sprengel deformity/ high scapula Scoliosis and/or kyphosis
CLINICAL FEATURES CONTD.. Musculoskeletal sys- cervical rib, congenital fusion of ribs, abnormal costovertebral joints, syndactyly, hypoplastic thumb, supernumerary digits, hypoplasia of pectoralis major, hemiatrophy of upper or lower limbs, CTEV, sacral agenesis Urinary tract abnormalities – agenesis of kidney, horseshoe kidney, hydronephrosis, tubular ectasia, renal ectopia, double collecting system Cardiovascular- VSD, PDA, coarctation of aorta, patent foramen ovale
CLINICAL FEATURES CONTD.. Deafness (absence of auditory canal and microtia) Synkinesia- involuntary paired movements of the hand ( mirror movements) Neurologic deficit- facial nerve Palsy, rectus muscle palsy, ptosis of eye, cleft palate, etc
RADIOLOGICAL FINDINGS Cervical spine routine x-ray  followed by flexion/extension lateral X-rays. These may show flattening and widening of vertebrae, hemivertebrae or block vertebrae, instability.  MRI with head flexed and extended will most accurately access subluxation and cord compression along with cord anomalies.  Wasp-waist sign- anterior concave indentation at the site of the absent or fused interspace between the fused vertebrae.  In the young child (<5y) the fusion is more apparent in the posterior elements.  X-rays of the T-spine because of extension of synostoses below the neck.
TREATMENT Medical therapy depends on the congenital anomalies present in the syndrome.  Referrals to Nephrology Urology Cardiology ENT    may be needed because of the associated anomalies NEUROSURGEON
TREATMENT Minimally involved patients lead normal lives with only minor restrictions.  Should avoid contact sports that place neck at risk.  For mechanical symptoms, cervical collar, analgesics, NSAIDS, or careful traction can be used.  For neurologic compromise a thorough work-up to find the exact area of irritation, then fusion of the appropriate segments posteriorly. Decompression may be employed based on the site of the stenosis.  Dislocations and basilar invagination are treated by careful traction followed by posterior fusion.  Neurologic deficits and persistent pain are indications for surgery

Más contenido relacionado

La actualidad más candente

Posterior circulation stroke
Posterior circulation strokePosterior circulation stroke
Posterior circulation stroke
Sarath Cherukuri
 

La actualidad más candente (20)

Congenital brain anomalies
Congenital brain anomaliesCongenital brain anomalies
Congenital brain anomalies
 
Posterior circulation stroke
Posterior circulation strokePosterior circulation stroke
Posterior circulation stroke
 
Approach to a patient of spastic paraplegia
Approach to a patient of spastic paraplegiaApproach to a patient of spastic paraplegia
Approach to a patient of spastic paraplegia
 
Brainstem syndrome vinod (1)
Brainstem syndrome vinod (1)Brainstem syndrome vinod (1)
Brainstem syndrome vinod (1)
 
Anatomy of cerebral veins
Anatomy of cerebral veinsAnatomy of cerebral veins
Anatomy of cerebral veins
 
foot drop
foot dropfoot drop
foot drop
 
Brain herniation imaging
Brain herniation imagingBrain herniation imaging
Brain herniation imaging
 
False localising signs : a major examination finding
False localising signs : a major examination findingFalse localising signs : a major examination finding
False localising signs : a major examination finding
 
Approach to Ataxia
Approach to AtaxiaApproach to Ataxia
Approach to Ataxia
 
Compressive Myelopathy
Compressive MyelopathyCompressive Myelopathy
Compressive Myelopathy
 
Chiari malformation
Chiari malformationChiari malformation
Chiari malformation
 
CNS infections in HIV
CNS infections in HIVCNS infections in HIV
CNS infections in HIV
 
Approach to white matter disease
Approach to white matter diseaseApproach to white matter disease
Approach to white matter disease
 
Clinical Approach to Paraplegia
Clinical Approach to ParaplegiaClinical Approach to Paraplegia
Clinical Approach to Paraplegia
 
Localization In Clinical Neurology
Localization In Clinical NeurologyLocalization In Clinical Neurology
Localization In Clinical Neurology
 
Approach to quadriparesis
Approach to quadriparesisApproach to quadriparesis
Approach to quadriparesis
 
Non compressive myelopathy
Non compressive myelopathyNon compressive myelopathy
Non compressive myelopathy
 
MRI brain; Basics and Radiological Anatomy
MRI brain; Basics and Radiological AnatomyMRI brain; Basics and Radiological Anatomy
MRI brain; Basics and Radiological Anatomy
 
Anterior cerebral circulation
Anterior cerebral circulationAnterior cerebral circulation
Anterior cerebral circulation
 
Cvj anomalies
Cvj anomaliesCvj anomalies
Cvj anomalies
 

Destacado

Cv Junction Anomaly
Cv Junction AnomalyCv Junction Anomaly
Cv Junction Anomaly
rajasekar
 
Cranio vertebral anomalies
Cranio vertebral anomaliesCranio vertebral anomalies
Cranio vertebral anomalies
Ankur Varshney
 
Craniovetebraljunction
CraniovetebraljunctionCraniovetebraljunction
Craniovetebraljunction
Kiran Kumar
 
Cranio-vertrable junction anamolies
Cranio-vertrable junction anamoliesCranio-vertrable junction anamolies
Cranio-vertrable junction anamolies
Abhay Mange
 
Imaging the cv junction.part 2. himadri s das
Imaging the cv junction.part 2. himadri s dasImaging the cv junction.part 2. himadri s das
Imaging the cv junction.part 2. himadri s das
Dr. Himadri Sikhor Das
 
Hereditary spastic paraplegia
Hereditary spastic paraplegiaHereditary spastic paraplegia
Hereditary spastic paraplegia
zubair314
 
Case ivc filter in pregnancy
Case ivc filter in pregnancyCase ivc filter in pregnancy
Case ivc filter in pregnancy
Waled Abohatab
 

Destacado (20)

Cv Junction Anomaly
Cv Junction AnomalyCv Junction Anomaly
Cv Junction Anomaly
 
Cranio vertebral anomalies
Cranio vertebral anomaliesCranio vertebral anomalies
Cranio vertebral anomalies
 
Cranio vertebral anomalies- overview -
Cranio vertebral anomalies- overview - Cranio vertebral anomalies- overview -
Cranio vertebral anomalies- overview -
 
A Case of Klippel Feil anomaly with Sprengel Shoulder
A Case of Klippel Feil anomaly with Sprengel ShoulderA Case of Klippel Feil anomaly with Sprengel Shoulder
A Case of Klippel Feil anomaly with Sprengel Shoulder
 
CV junction
CV junction CV junction
CV junction
 
Recurrence of Klippel-Trenaunay syndrome symptoms after surgery: a single cas...
Recurrence of Klippel-Trenaunay syndrome symptoms after surgery: a single cas...Recurrence of Klippel-Trenaunay syndrome symptoms after surgery: a single cas...
Recurrence of Klippel-Trenaunay syndrome symptoms after surgery: a single cas...
 
Lec.9 diaphragm pt&rt
Lec.9 diaphragm pt&rtLec.9 diaphragm pt&rt
Lec.9 diaphragm pt&rt
 
Craniovetebraljunction
CraniovetebraljunctionCraniovetebraljunction
Craniovetebraljunction
 
Cranio-vertrable junction anamolies
Cranio-vertrable junction anamoliesCranio-vertrable junction anamolies
Cranio-vertrable junction anamolies
 
Imaging the cv junction.part 2. himadri s das
Imaging the cv junction.part 2. himadri s dasImaging the cv junction.part 2. himadri s das
Imaging the cv junction.part 2. himadri s das
 
Pulmonary emoblism by dr yaser
Pulmonary emoblism  by dr yaserPulmonary emoblism  by dr yaser
Pulmonary emoblism by dr yaser
 
Clinical meet
Clinical meetClinical meet
Clinical meet
 
Prashant gmc cvj
Prashant gmc cvjPrashant gmc cvj
Prashant gmc cvj
 
imaging of the craniovertebral junction
imaging of the craniovertebral junction imaging of the craniovertebral junction
imaging of the craniovertebral junction
 
About Klippel-Trenaunay Syndrome
About Klippel-Trenaunay SyndromeAbout Klippel-Trenaunay Syndrome
About Klippel-Trenaunay Syndrome
 
Cv junction
Cv junctionCv junction
Cv junction
 
Tumours of nasopharynx (2) itp class dr.davis - 03.06.16
Tumours of nasopharynx (2) itp class   dr.davis - 03.06.16Tumours of nasopharynx (2) itp class   dr.davis - 03.06.16
Tumours of nasopharynx (2) itp class dr.davis - 03.06.16
 
Hereditary spastic paraplegia
Hereditary spastic paraplegiaHereditary spastic paraplegia
Hereditary spastic paraplegia
 
Craniovertebral juction 1 by dr mohammad mushtaq
Craniovertebral juction 1 by dr mohammad mushtaqCraniovertebral juction 1 by dr mohammad mushtaq
Craniovertebral juction 1 by dr mohammad mushtaq
 
Case ivc filter in pregnancy
Case ivc filter in pregnancyCase ivc filter in pregnancy
Case ivc filter in pregnancy
 

Similar a A Case Of Short Neck

Syringomyelia
SyringomyeliaSyringomyelia
Syringomyelia
Subbu Raj
 
Cervical myelopathy cme
Cervical myelopathy cmeCervical myelopathy cme
Cervical myelopathy cme
group7usmkk
 
Pediatric Neurologic Disorders
Pediatric Neurologic Disorders Pediatric Neurologic Disorders
Pediatric Neurologic Disorders
Tosca Torres
 
Chiari Malformations By Eric Trumble, MD
Chiari Malformations By Eric Trumble, MDChiari Malformations By Eric Trumble, MD
Chiari Malformations By Eric Trumble, MD
floridahospital
 

Similar a A Case Of Short Neck (20)

Acase of Klippel feil syndrome
Acase of Klippel feil syndrome Acase of Klippel feil syndrome
Acase of Klippel feil syndrome
 
Syringomyelia
SyringomyeliaSyringomyelia
Syringomyelia
 
A Case of Syringomyelia with Arnold-Chiari Malformation
A Case of Syringomyelia with Arnold-Chiari Malformation A Case of Syringomyelia with Arnold-Chiari Malformation
A Case of Syringomyelia with Arnold-Chiari Malformation
 
NEURO_Myopathy (1).pptx
NEURO_Myopathy (1).pptxNEURO_Myopathy (1).pptx
NEURO_Myopathy (1).pptx
 
Parkinsonism & Alzheimer's disease
Parkinsonism & Alzheimer's diseaseParkinsonism & Alzheimer's disease
Parkinsonism & Alzheimer's disease
 
Approach_to_floppy_infant__1_.pptx
Approach_to_floppy_infant__1_.pptxApproach_to_floppy_infant__1_.pptx
Approach_to_floppy_infant__1_.pptx
 
Cerebral Palsy in Children
Cerebral Palsy in Children Cerebral Palsy in Children
Cerebral Palsy in Children
 
Movement disorders.2013
Movement disorders.2013Movement disorders.2013
Movement disorders.2013
 
PERTHES DISEASE
PERTHES  DISEASEPERTHES  DISEASE
PERTHES DISEASE
 
Diffuse idiopathic skeletal hyperostosis
Diffuse idiopathic skeletal hyperostosisDiffuse idiopathic skeletal hyperostosis
Diffuse idiopathic skeletal hyperostosis
 
Cerebral palsy by Dr vijitha
Cerebral palsy by Dr vijithaCerebral palsy by Dr vijitha
Cerebral palsy by Dr vijitha
 
Cervical myelopathy cme
Cervical myelopathy cmeCervical myelopathy cme
Cervical myelopathy cme
 
Spinabifida andphysiotherapy
Spinabifida andphysiotherapySpinabifida andphysiotherapy
Spinabifida andphysiotherapy
 
Ultrasound image gallery
Ultrasound image galleryUltrasound image gallery
Ultrasound image gallery
 
Pediatric Neurologic Disorders
Pediatric Neurologic Disorders Pediatric Neurologic Disorders
Pediatric Neurologic Disorders
 
cerebral palsy
 cerebral palsy cerebral palsy
cerebral palsy
 
Hereditary spastic paraplegia
Hereditary spastic paraplegiaHereditary spastic paraplegia
Hereditary spastic paraplegia
 
Frontal syndrome and mid-brain lesion
Frontal syndrome and mid-brain lesionFrontal syndrome and mid-brain lesion
Frontal syndrome and mid-brain lesion
 
Final case presentation sci (kimberly walsh)
Final case presentation sci (kimberly walsh)Final case presentation sci (kimberly walsh)
Final case presentation sci (kimberly walsh)
 
Chiari Malformations By Eric Trumble, MD
Chiari Malformations By Eric Trumble, MDChiari Malformations By Eric Trumble, MD
Chiari Malformations By Eric Trumble, MD
 

Más de Stanley Medical College, Department of Medicine

Más de Stanley Medical College, Department of Medicine (20)

Interpretation of Liver Function Tests
Interpretation of Liver Function TestsInterpretation of Liver Function Tests
Interpretation of Liver Function Tests
 
A Case of Sheehan's Syndrome
A Case of Sheehan's SyndromeA Case of Sheehan's Syndrome
A Case of Sheehan's Syndrome
 
Imaging: Cortical Vein Thrombosis
Imaging: Cortical Vein ThrombosisImaging: Cortical Vein Thrombosis
Imaging: Cortical Vein Thrombosis
 
ECG: Findings in CNS disorders
ECG: Findings in CNS disordersECG: Findings in CNS disorders
ECG: Findings in CNS disorders
 
A Case of Arrhythmogenic Right Ventricular Dysplasia - ARVD
A Case of Arrhythmogenic Right Ventricular Dysplasia - ARVDA Case of Arrhythmogenic Right Ventricular Dysplasia - ARVD
A Case of Arrhythmogenic Right Ventricular Dysplasia - ARVD
 
A Case of NASH with HYPOTHYROIDISM
A Case of NASH with HYPOTHYROIDISMA Case of NASH with HYPOTHYROIDISM
A Case of NASH with HYPOTHYROIDISM
 
IMAGING: NEUROCYSTICERCOSIS
IMAGING: NEUROCYSTICERCOSISIMAGING: NEUROCYSTICERCOSIS
IMAGING: NEUROCYSTICERCOSIS
 
ECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AFECG: Digitalis Effect / MAT / AF
ECG: Digitalis Effect / MAT / AF
 
Imaging: BOOP
Imaging: BOOPImaging: BOOP
Imaging: BOOP
 
ECG: Hypokalemia
ECG: HypokalemiaECG: Hypokalemia
ECG: Hypokalemia
 
A Case of Idiopathic Pulmonary Hypertension
A Case of Idiopathic Pulmonary HypertensionA Case of Idiopathic Pulmonary Hypertension
A Case of Idiopathic Pulmonary Hypertension
 
A Case of Schmidt Syndrome
A Case of Schmidt Syndrome A Case of Schmidt Syndrome
A Case of Schmidt Syndrome
 
A Case of Rodenticide Poisoning
A Case of Rodenticide PoisoningA Case of Rodenticide Poisoning
A Case of Rodenticide Poisoning
 
A Case of Emphysematous Pylonephritis
A Case of Emphysematous Pylonephritis A Case of Emphysematous Pylonephritis
A Case of Emphysematous Pylonephritis
 
Imaging: Multiple Pulmonary Cavitary Lesions
Imaging: Multiple Pulmonary Cavitary LesionsImaging: Multiple Pulmonary Cavitary Lesions
Imaging: Multiple Pulmonary Cavitary Lesions
 
ECG: Atrial Dissociation
ECG: Atrial DissociationECG: Atrial Dissociation
ECG: Atrial Dissociation
 
A Case of Hepato-Pulmonary Syndrome
A Case of Hepato-Pulmonary SyndromeA Case of Hepato-Pulmonary Syndrome
A Case of Hepato-Pulmonary Syndrome
 
A Case of Thalassemia
A Case of ThalassemiaA Case of Thalassemia
A Case of Thalassemia
 
A Case of Renal Amyloidosis
A Case of Renal AmyloidosisA Case of Renal Amyloidosis
A Case of Renal Amyloidosis
 
CXR: Silico-Tuberculosis
CXR: Silico-TuberculosisCXR: Silico-Tuberculosis
CXR: Silico-Tuberculosis
 

Último

👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
rajnisinghkjn
 
Premium Call Girls Nagpur {9xx000xx09} ❤️VVIP POOJA Call Girls in Nagpur Maha...
Premium Call Girls Nagpur {9xx000xx09} ❤️VVIP POOJA Call Girls in Nagpur Maha...Premium Call Girls Nagpur {9xx000xx09} ❤️VVIP POOJA Call Girls in Nagpur Maha...
Premium Call Girls Nagpur {9xx000xx09} ❤️VVIP POOJA Call Girls in Nagpur Maha...
Sheetaleventcompany
 
💚Chandigarh Call Girls Service 💯Piya 📲🔝8868886958🔝Call Girls In Chandigarh No...
💚Chandigarh Call Girls Service 💯Piya 📲🔝8868886958🔝Call Girls In Chandigarh No...💚Chandigarh Call Girls Service 💯Piya 📲🔝8868886958🔝Call Girls In Chandigarh No...
💚Chandigarh Call Girls Service 💯Piya 📲🔝8868886958🔝Call Girls In Chandigarh No...
Sheetaleventcompany
 
Difference Between Skeletal Smooth and Cardiac Muscles
Difference Between Skeletal Smooth and Cardiac MusclesDifference Between Skeletal Smooth and Cardiac Muscles
Difference Between Skeletal Smooth and Cardiac Muscles
MedicoseAcademics
 
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Sheetaleventcompany
 
❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
Sheetaleventcompany
 
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan 087776558899
 

Último (20)

Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
Chandigarh Call Girls Service ❤️🍑 9809698092 👄🫦Independent Escort Service Cha...
 
Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now
Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book nowChennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now
Chennai ❣️ Call Girl 6378878445 Call Girls in Chennai Escort service book now
 
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
👉 Chennai Sexy Aunty’s WhatsApp Number 👉📞 7427069034 👉📞 Just📲 Call Ruhi Colle...
 
Premium Call Girls Nagpur {9xx000xx09} ❤️VVIP POOJA Call Girls in Nagpur Maha...
Premium Call Girls Nagpur {9xx000xx09} ❤️VVIP POOJA Call Girls in Nagpur Maha...Premium Call Girls Nagpur {9xx000xx09} ❤️VVIP POOJA Call Girls in Nagpur Maha...
Premium Call Girls Nagpur {9xx000xx09} ❤️VVIP POOJA Call Girls in Nagpur Maha...
 
Call Girl In Chandigarh 📞9809698092📞 Just📲 Call Inaaya Chandigarh Call Girls ...
Call Girl In Chandigarh 📞9809698092📞 Just📲 Call Inaaya Chandigarh Call Girls ...Call Girl In Chandigarh 📞9809698092📞 Just📲 Call Inaaya Chandigarh Call Girls ...
Call Girl In Chandigarh 📞9809698092📞 Just📲 Call Inaaya Chandigarh Call Girls ...
 
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service AvailableCall Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
Call Girls Rishikesh Just Call 9667172968 Top Class Call Girl Service Available
 
💚Chandigarh Call Girls Service 💯Piya 📲🔝8868886958🔝Call Girls In Chandigarh No...
💚Chandigarh Call Girls Service 💯Piya 📲🔝8868886958🔝Call Girls In Chandigarh No...💚Chandigarh Call Girls Service 💯Piya 📲🔝8868886958🔝Call Girls In Chandigarh No...
💚Chandigarh Call Girls Service 💯Piya 📲🔝8868886958🔝Call Girls In Chandigarh No...
 
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptxANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF REPRODUCTIVE SYSTEM.pptx
 
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
7 steps How to prevent Thalassemia : Dr Sharda Jain & Vandana Gupta
 
Difference Between Skeletal Smooth and Cardiac Muscles
Difference Between Skeletal Smooth and Cardiac MusclesDifference Between Skeletal Smooth and Cardiac Muscles
Difference Between Skeletal Smooth and Cardiac Muscles
 
Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos a...
Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos a...Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos a...
Call girls Service Phullen / 9332606886 Genuine Call girls with real Photos a...
 
Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...
Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...
Race Course Road } Book Call Girls in Bangalore | Whatsapp No 6378878445 VIP ...
 
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
Goa Call Girl Service 📞9xx000xx09📞Just Call Divya📲 Call Girl In Goa No💰Advanc...
 
❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
❤️Amritsar Escorts Service☎️9815674956☎️ Call Girl service in Amritsar☎️ Amri...
 
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
Cara Menggugurkan Kandungan Dengan Cepat Selesai Dalam 24 Jam Secara Alami Bu...
 
Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
Kolkata Call Girls Naktala  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Girl Se...Kolkata Call Girls Naktala  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Girl Se...
Kolkata Call Girls Naktala 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Girl Se...
 
Cardiac Output, Venous Return, and Their Regulation
Cardiac Output, Venous Return, and Their RegulationCardiac Output, Venous Return, and Their Regulation
Cardiac Output, Venous Return, and Their Regulation
 
tongue disease lecture Dr Assadawy legacy
tongue disease lecture Dr Assadawy legacytongue disease lecture Dr Assadawy legacy
tongue disease lecture Dr Assadawy legacy
 
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...
Kolkata Call Girls Shobhabazar  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Gir...Kolkata Call Girls Shobhabazar  💯Call Us 🔝 8005736733 🔝 💃  Top Class Call Gir...
Kolkata Call Girls Shobhabazar 💯Call Us 🔝 8005736733 🔝 💃 Top Class Call Gir...
 
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptxANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
ANATOMY AND PHYSIOLOGY OF RESPIRATORY SYSTEM.pptx
 

A Case Of Short Neck

  • 1. A CASE OF SHORT NECK PROF.S.TITO’S UNIT
  • 2.
  • 3.
  • 4. No h/o diff in passing through narrow pathways No h/o sensory disturbancces h/o diff in walking in darkness,&face wash No h/o olfactory, visual disturbances No h/o motor and sensory abnormalities of face h/o change of voice -3months No h/o other cranial nerve disturbances No h/o bladder,bowel and other autonomic disturbances
  • 5. PAST HISTORY; No h/o DM,HT,TB h/0 trauma falling from height present treated as IP in hospital 2 months records not available at 2 yrs of age. Personal history; occ.smoker,alcoholic Family history; no h/o any relevant illness
  • 6. GENERAL EXAMINATION Pt conscious,oriented,notanaemic not jaundiced,nocyanosis,no clubbing ,no gla. Height:neck ratio 19:1 Webbing of neck Low hair line sprengel’s anomaly Left hemiatrophy Restricted neck movts on side to side Prominent epiglottis on opening mouth Mirror movements-synkinesia Pulse 70/mt,BP102/66 mmhg
  • 7. SHORT NECK LOW HAIRLINE
  • 11. HMF-NORMAL Cranial nerves;1,2,3,4,,6,7-normal 5th nerve – lt side diminished cor reflex dim. touch sensation with brisk jaw jerk 8th nerve conductive deafness lt side 9&10 nerves gag reflex diminished 11th nerve normal 12th nerve normal
  • 12. Motor system Superficial reflexes –abdominal and cremasteric reflex present
  • 14. Sensory system Pain and temperarure-normal Joint position and vibration sense diminished in all four limbs incl.vertebral Romberg’s sign positive
  • 15. CEREBELLUM No nystagmus Finger nose,figer-finger-nose defective Lt.side No Dysdiaadokinesia,slurring of speech present Heel-shin test positive-lt side Tandem walking-defective
  • 18.
  • 20. MCGREGOR’S LINE (Basal line)- Joins hard palate to lowest point of occipital bone Tip of dens should not exceed 5 mm above this line Mcgregor`s Line
  • 21. Height Index Of Klaus HEIGHT INDEX OF KLAUS – dense to tuberculam line < 30 basillarinvagination
  • 22. McRae’s LINE Joins anterior and posterior edges of foramen magnum: sagittal diameter of foramen magnum. (Avg – 35mm);dense below the line foramen stenosis McRae`s Line
  • 24.
  • 27. KLIPPEL FEIL SYNDROME Congenital fusion of cervical vertebrae Failure of normal segmentation of the cervical vertebrae/somite between 3rd and 8th weeks of fetal development (rather than a secondary fusion) Maurice Klippel and Andre Feil – 1912 Incidence – 1 in 42,000 births ; more in females Autosomal dominant inheritance – C2-C3 fusion. Autosomal recessive – C5- C6 fusion
  • 28. CLASSIFICATION Feil’s classification Type I – massive fusion of many cervical and upper thoracic vertebrae with synostosis Type II – fusion of only 1 or 2 vertebrae (with hemivertebrae , scoliosis, occipitoatlantoid fusion) Type III – presence of lower thoracic and upper lumbar spine anomalies with I/II Type IV – sacral agenesis Samartzis’s classification (2006) To clarify prognosis Type I – single congenitally fused cervical segment Type II – multiple non-contiguous fused segments Type III – multiple contiguous fused segments
  • 29. CLINICAL FEATURES Patients with upper cervical spine involvement tend to present at an earlier age than those whose with lower cervical spine involvement Rotational loss and lateral bending is usually more pronounced than loss of flexion and extension because latter movements take place mostly between occiput and atlas Scoliosis – some patients congenital due to involvement of thoracic spine , others scoliosis compensatory to cervical scoliosis
  • 30. FEIL’S TRIAD Low posterior hair line Short neck Limitation of head and neck movements / decreased range of motion in cervical spine
  • 31. CLINICAL FEATURES Webbing of soft tissues on each side of the neck (extending from mastoid process to acromion of shoulders)- ‘pterygiumcolli’ torticollis due to contracture of sternocleidomastoid muscle or bony abnormalities Facial asymmetry Sprengel deformity/ high scapula Scoliosis and/or kyphosis
  • 32. CLINICAL FEATURES CONTD.. Musculoskeletal sys- cervical rib, congenital fusion of ribs, abnormal costovertebral joints, syndactyly, hypoplastic thumb, supernumerary digits, hypoplasia of pectoralis major, hemiatrophy of upper or lower limbs, CTEV, sacral agenesis Urinary tract abnormalities – agenesis of kidney, horseshoe kidney, hydronephrosis, tubular ectasia, renal ectopia, double collecting system Cardiovascular- VSD, PDA, coarctation of aorta, patent foramen ovale
  • 33. CLINICAL FEATURES CONTD.. Deafness (absence of auditory canal and microtia) Synkinesia- involuntary paired movements of the hand ( mirror movements) Neurologic deficit- facial nerve Palsy, rectus muscle palsy, ptosis of eye, cleft palate, etc
  • 34. RADIOLOGICAL FINDINGS Cervical spine routine x-ray followed by flexion/extension lateral X-rays. These may show flattening and widening of vertebrae, hemivertebrae or block vertebrae, instability. MRI with head flexed and extended will most accurately access subluxation and cord compression along with cord anomalies. Wasp-waist sign- anterior concave indentation at the site of the absent or fused interspace between the fused vertebrae. In the young child (<5y) the fusion is more apparent in the posterior elements. X-rays of the T-spine because of extension of synostoses below the neck.
  • 35. TREATMENT Medical therapy depends on the congenital anomalies present in the syndrome. Referrals to Nephrology Urology Cardiology ENT may be needed because of the associated anomalies NEUROSURGEON
  • 36. TREATMENT Minimally involved patients lead normal lives with only minor restrictions. Should avoid contact sports that place neck at risk. For mechanical symptoms, cervical collar, analgesics, NSAIDS, or careful traction can be used. For neurologic compromise a thorough work-up to find the exact area of irritation, then fusion of the appropriate segments posteriorly. Decompression may be employed based on the site of the stenosis. Dislocations and basilar invagination are treated by careful traction followed by posterior fusion. Neurologic deficits and persistent pain are indications for surgery
  • 37. THANK YOU