gms | German Medical Science

Objective: Lesions of the upper cervical cord after trauma have never been systematically reported in literature, although they can be occasionally assumed in clinical pratice. Nothing is known about their clinical and radiological feature and they have never beeen systemaised.

Method: Cranial magnetic resonance imaging (MRI) was performed in 250 patients who had been unconscious post-trauma for at least 24hours. MRI evaluatuions was carried out within 8 days after severe brain injury (TBI). The frequency and the characteristics of injuries to the upper cervical myelon were determined.

Results: No lesions of the upper cervical medulla were found without accompanying damage to the medulla oblongata. Two groups were found to have a lesion in the upper cervical myelon. In 3.2% of the patients in a state of deep coma MRI revealed lesions in the entire brain stem. These died without waking from coma. 2% of the patients were found to have additional damage to the distal medulla oblongata. These victims of high-speed traumas awoke from coma after 2-3 days. They revealed frontal contusions of the brain and traumatic subarachnoidal hemorrhages. Injuries to the bony upper cervical spine and/or the skull base were frequent. Four of them died, one patient survived with severe disabilities.

Conclusions: The trauma of the upper cervical cord is apparent after severe TBI in 2.5% of the cases. Radiological predictors are osseous lesions in base of skull, atlas and dens in combination of frontal contusions. Two types of lesions could be differentiated, both of which occur only in association with lesions in the medulla oblongata. The view on MRI allows therapeutical decisions and prognostic evaluation along a classification of the subtypes.