Published online Oct 28, 2015. doi: 10.4329/wjr.v7.i10.357
Peer-review started: April 8, 2015
First decision: May 13, 2015
Revised: June 23, 2015
Accepted: June 30, 2015
Article in press: July 2, 2015
Published online: October 28, 2015
Processing time: 210 Days and 5.9 Hours
Ligament disruptions at the craniovertebral junction are typically associated with atlantoaxial rotatory dislocation during upper cervical spine injuries and require external orthoses or surgical stabilization. Only in few patients isolated ruptures of the alar ligament have been reported. Here we present a further case, in which the diagnosis was initially obscured by a misleading clinical symptomatology but finally established six month following the trauma, demonstrating the value of contrast-enhanced high resolution 3 Tesla magnetic resonance imaging in identifying this particular lesion.
Core tip: Upper cervical spine injuries are common and bear a relevant medical and socioeconomic impact. While most of such lesions are related to atlantoaxial rotatory dislocation, thus far only few patients with isolated alar ligament ruptures have been reported. This particular trauma is a challenge to both clinicians and radiologists and diagnosis might thus be delayed. Here we present a further case of a young adult and discuss the value of sequential contrast-enhanced magnetic resonance imaging in establishing this diagnosis at a late stage and in the follow-up of a subsequently prolonged recovery.