Simple and complex febrile seizures: is there such a difference? Management and complications in an emergency department.

OBJECTIVE: We aimed to analyse the prevalence, characteristics, and management of simple and complex febrile seizures. The secondary objective was to compare the risk of underlying organic lesion and epilepsy in both types of seizures, with a particular focus on the different subtypes defining a complex febrile seizure. MATERIAL AND METHODS: We performed a retrospective cohort study including patients aged 0--16 years who were treated for febrile seizures in the paediatric emergency department of a tertiary hospital over a period of 5 years. Epidemiological and clinical variables were collected. Patients were followed up for at least 2 years to confirm the final diagnosis. RESULTS: We identified 654 patients with febrile seizures, with a prevalence of 0.20% (95% CI, 0.18-0.22); 537 (82%) had simple febrile seizures and 117 (18%) had complex febrile seizures. The clinical and epidemiological characteristics of both types were similar. Significantly more complementary tests were requested for complex febrile seizures: blood tests (71.8% vs 24.2% for simple febrile seizures), urine analysis (10.3% vs 2.4%), lumbar puncture (14.5% vs 1.5%), and CT (7.7% vs 0%). Similarly, admission was indicated more frequently (41.0% vs 6.1%). Underlying organic lesions (central nervous system infection, metabolic disease, tumour/intracranial space-occupying lesion, intoxication) were diagnosed in only 11 patients, 5 of whom had complex forms (4.3%; 95% CI, 0.6-7.9). Risk factors for developing epilepsy, identified in the multivariate analysis, were complex forms with recurrent seizures in a single attack (odds ratio [OR]: 4.94; 95% CI, 1.29-18.95), history of seizures (OR: 17.97; 95% CI, 2.26--143.10), and seizures presenting at atypical ages (OR: 11.69; 95% CI, 1.99-68.61). CONCLUSIONS: The systematic indication of complementary tests or hospital admission of patients with complex febrile seizures is unnecessary. The risk of epilepsy in patients with complex forms gives rise to the need for follow-up in paediatric neurology departments.

Convulsiones febriles simples y complejas, ¿son tan diferentes? Manejo y complicaciones en urgencias / Simple and complex febrile seizures: is there such a difference? Management and complications in an emergency department

Objetivo: Analizar la prevalencia, características y manejo de las convulsiones febriles simples y complejas. Secundariamente, comparar el riesgo de lesión orgánica subyacente y epilepsia entre ambos tipos de crisis y particularmente de cada subtipo que define una convulsión febril compleja. Material y método: Estudio de cohortes retrospectivo que incluye pacientes de 0-16 años que consultan por convulsión febril en urgencias pediátricas de un hospital terciario durante 5 años. Se recogen variables epidemiológicas y clínicas. Se realiza un seguimiento posterior mínimo de 2 años para confirmar el diagnóstico final. Resultados: Se incluyeron 654 convulsiones febriles, con una prevalencia del 0,20% (IC 95%: 0,18-0,22%); 537 fueron simples (82%) y 117 complejas (18%). Las características clínico-epidemiológicas de ambos tipos fueron similares. En las formas complejas se solicitaron significativamente más pruebas complementarias en forma de analíticas (71,8% vs. 24,2%), tóxicos (10,3% vs. 2,4%), punción lumbar (14,5% vs. 1,5%) y TAC (7,7% vs. 0%). Igualmente se indicó ingreso con mayor frecuencia (41,0% vs. 6,1%). No se diagnosticó ninguna lesión orgánica subyacente (infección del sistema nervioso central, enfermedad metabólica, tumor/lesión intracraneal ocupante de espacio, intoxicación) excepto 11 casos de epilepsia, 5 de ellas en las formas complejas (4,3%; IC 95%: 0,6-7,9%). En el análisis multivariable presentaron mayor riesgo de desarrollar epilepsia las formas complejas por ser recurrentes en el mismo proceso febril (odds ratio [OR]: 4,94; IC 95%: 1,29-18,95), aquellos con antecedentes de crisis previas (OR: 17,97; IC 95%: 2,26-143,10) y las manifestadas a edades atípicas (OR: 11,69; IC 95%: 1,99-68,61). Conclusiones: No está justificada la indicación sistemática de pruebas complementarias o ingreso en las convulsiones febriles complejas. El riesgo de epilepsia en las formas complejas hace necesario el seguimiento en neuropediatría. (AU)

Objective: We aimed to analyse the prevalence, characteristics, and management of simple and complex febrile seizures. The secondary objective was to compare the risk of underlying organic lesion and epilepsy in both types of seizures, with a particular focus on the different subtypes defining a complex febrile seizure. Material and methods: We performed a retrospective cohort study including patients aged 0-16 years who were treated for febrile seizures in the paediatric emergency department of a tertiary hospital over a period of 5 years. Epidemiological and clinical variables were collected. Patients were followed up for at least 2 years to confirm the final diagnosis. Results: We identified 654 patients with febrile seizures, with a prevalence of 0.20% (95% CI, 0.18-0.22); 537 (82%) had simple febrile seizures and 117 (18%) had complex febrile seizures. The clinical and epidemiological characteristics of both types were similar. Significantly more complementary tests were requested for complex febrile seizures: blood tests (71.8% vs 24.2% for simple febrile seizures), urine analysis (10.3% vs 2.4%), lumbar puncture (14.5% vs 1.5%), and CT (7.7% vs 0%). Similarly, admission was indicated more frequently (41.0% vs 6.1%). Underlying organic lesions (central nervous system infection, metabolic disease, tumour/intracranial space-occupying lesion, intoxication) were diagnosed in only 11 patients, 5 of whom had complex forms (4.3%; 95% CI, 0.6-7.9). Risk factors for developing epilepsy, identified in the multivariate analysis, were complex forms with recurrent seizures in a single attack (odds ratio [OR]: 4.94; 95% CI, 1.29-18.95), history of seizures (OR: 17.97; 95% CI, 2.26-143.10), and seizures presenting at atypical ages (OR: 11.69; 95% CI, 1.99-68.61). Conclusions: The systematic indication of complementary tests or hospital admission of patients with complex febrile seizures is unnecessary. [...] (AU)

Video discharge instructions for pediatric gastroenteritis in an emergency department: a randomized, controlled trial.

The aim was to evaluate if the addition of video discharge instructions (VDIs) to usual verbal information improved the comprehension of information provided to caregivers of patients who consult for acute gastroenteritis (AGE). We conducted an open-label, parallel, randomized trial, enrolling patients who consulted for AGE at a tertiary hospital. First, caregivers answered a written test concerning AGE characteristics and management. They were randomly allocated to a control group, which received the usual verbal instructions, or to an intervention group, which additionally received VDI. After discharge, caregivers were contacted by telephone and answered the same test, satisfaction questions, and follow-up information. From September 2019 to March 2020, 139 patients were randomized, 118 completed follow-up. The mean score was 3.13 (SD 1.07) over 5 points in the initial test and 3.96 (SD 0.96) in the follow-up test. Patients in the intervention group had a greater improvement (1.17 points, SD 1.11) than those in the control group (0.47 points, SD 0.94, p < 0.001). In the follow-up test, 49.1% in the intervention group and 18.6% in the control group answered all questions correctly (p < 0.001). There were no significant differences in return visits. Caregivers gave high satisfaction scores regardless of the allocation group.Conclusion: Video instructions improve caregivers' understanding of discharge information.Trial registration: [NCT04463355, retrospectively registered July 9, 2020]. What is Known: • Poor comprehension of discharge instructions leads to incorrect treatment after discharge, increased readmissions and a reduction of caregivers' satisfaction. • Video discharge instructions are useful providing concise information independently of the patients' health literacy level or communication skills of the health care provider What is New: • The addition of video discharge instructions to verbal instructions improves caregivers' knowledge about AGE improved with respect to those who only receive verbal instructions • Video instructions do not add extra time to the emergency department visits.

Simple and complex febrile seizures: is there such a difference? Management and complications in an emergency department. / Convulsiones febriles simples y complejas, ¿son tan diferentes? Manejo y complicaciones en urgencias.

OBJECTIVE: We aimed to analyse the prevalence, characteristics, and management of simple and complex febrile seizures. The secondary objective was to compare the risk of underlying organic lesion and epilepsy in both types of seizures, with a particular focus on the different subtypes defining a complex febrile seizure. MATERIAL AND METHODS: We performed a retrospective cohort study including patients aged 0-16 years who were treated for febrile seizures in the paediatric emergency department of a tertiary hospital over a period of 5 years. Epidemiological and clinical variables were collected. Patients were followed up for at least 2 years to confirm the final diagnosis. RESULTS: We identified 654 patients with febrile seizures, with a prevalence of 0.20% (95% CI, 0.18-0.22); 537 (82%) had simple febrile seizures and 117 (18%) had complex febrile seizures. The clinical and epidemiological characteristics of both types were similar. Significantly more complementary tests were requested for complex febrile seizures: blood tests (71.8% vs 24.2% for simple febrile seizures), urine analysis (10.3% vs 2.4%), lumbar puncture (14.5% vs 1.5%), and CT (7.7% vs 0%). Similarly, admission was indicated more frequently (41.0% vs 6.1%). Underlying organic lesions (central nervous system infection, metabolic disease, tumour/intracranial space-occupying lesion, intoxication) were diagnosed in only 11 patients, 5 of whom had complex forms (4.3%; 95% CI, 0.6-7.9). Risk factors for developing epilepsy, identified in the multivariate analysis, were complex forms with recurrent seizures in a single attack (odds ratio [OR]: 4.94; 95% CI, 1.29-18.95), history of seizures (OR: 17.97; 95% CI, 2.26-143.10), and seizures presenting at atypical ages (OR: 11.69; 95% CI, 1.99-68.61). CONCLUSIONS: The systematic indication of complementary tests or hospital admission of patients with complex febrile seizures is unnecessary. The risk of epilepsy in patients with complex forms gives rise to the need for follow-up in paediatric neurology departments.

[Impact of a strategy to improve the quality of care and risk management in a paediatric emergency department]. / Impacto de una estrategia de mejora de calidad asistencial y gestión de riesgos en un servicio de urgencias pediátricas.

INTRODUCTION: Emergency departments are a high risk area for the occurrence of adverse events. The aim of this study is to analyse the impact of a strategy to improve the quality assurance and risk management in the notification of incidents in our Unit, and describe the improvement actions developed from the reported incidents. MATERIAL AND METHODS: A retrospective observational study was developed during one year, divided into two periods: P1 (Start: training session and implementation of the risk management process), and P2 (Start: feed-back session of incidents reported in P1 and improvement actions developed). In each period, the number of reported incidents in relation to the number of emergencies attended (‰) and the descriptive data of each incident were recorded. The improvement actions developed from the incidents reported in P1 were described. RESULTS: The number of notifications from P1 (4.1‰; 95%CI 3.2-5.0‰) increased in P2 (10.9‰; 95%CI 9.8-10.2‰, P<.001). The most frequent incidents in P1 were medication (33.3%), and identification errors (25.9%): both were significantly reduced in P2 (16.9%, P=.001 and 9.3%, P<.001, respectively). In P2, prescription errors of the P1 were reduced (35.9% vs 62.9%, P=.02). The factors of "Knowledge and training" (23.5%) were the most frequent in P1, decreasing in P2 (7.4%, P<.001). CONCLUSION: It is considered that the implementation of a risk management process, and the promotion of a safety culture, through training and feed-back sessions to all professionals, contributed to increase the volume of notifications in our Unit. The voluntary and anonymous reporting of incidents is useful to identify risks, and plan corrective measures, contributing to improve quality assurance and patient safety.

Presencia de anticuerpos antifosfolípidos en niños con fiebre y petequias / Presence of antiphospholipid antibodies in children with fever and petechiae

Introducción: La presencia de un tiempo de cefalina (APTT) alargado en niños con fiebre y petequias es un hallazgo descrito en la bibliografía. La causa de esta alteración se desconoce, pero se postula que puede deberse a la formación de anticuerpos antifosfolípidos (Ac AFL). El objetivo de este estudio es determinar si el alargamiento del APTT se asocia con la formación Ac AFL. Pacientes y métodos: Estudio observacional, prospectivo, de casos y controles, realizado en niños que consultaron por fiebre y petequias en el servicio de urgencias de un hospital de tercer nivel durante un periodo de 13 meses. Se recogieron variables epidemiológicas, clínicas y analíticas. Se describieron las características de los grupos con APTT alargado y normal, y se comparó la asociación entre las concentraciones de los diferentes anticuerpos y el APTT. Resultados: Se incluyeron 36 pacientes, 12 casos y 24 controles. No se encontraron diferencias significativas respecto a la positividad de Ac AFL entre los casos y los controles (odds ratio [OR]= 1,67; intervalo de confianza [IC] del 95%: 0,31-9,04). No se observó ninguna asociación entre los diferentes tipos de anticuerpos y el APTT, cuyos coeficientes de regresión fueron de 0,04 seg (IC del 95%: -0,31 a 0,40) para anticardiolipina IgG, de 1,11 seg (IC del 95%: -1,24 a 3,46) para la IgM, y de -0,02 seg (IC del 95%: -0,35 a 0,31) y 0,64 seg (IC del 95%: -1,40 a 2,68) para antibeta 2 GPI, IgG e IgM, respectivamente. Conclusión: Ante los resultados de nuestro estudio, no podemos concluir que el alargamiento de APTT se relacione con la presencia de Ac AFL (AU)

Introduction: The presence of a longer time of cephalin (APTT) extended in children who come to emergency department with fever and petechiae is a result previously described in the literature. The cause of this alteration in coagulation is unknown, it is presumed that may be due to the formation of antiphospholipids antibodies. The aim of this study is to determine if the length of APTT is associated to the formation of antiphospholipids antibodies. Patients and methods: Observational, prospective case-control study in children who consulted for fever and petechiae in the emergency department of a tertiary hospital over a 13-month period epidemiological; clinical and laboratory variables were collected. The characteristics of groups with elongated and normal APTT were described and the association between concentrations of different antibodies and APTT were compared. Results: 36 patients, 12 cases and 24 controls, were included. No significant differences were found regarding the positivity of antiphospholipid antibodies between cases and controls (OR= 1.67; 95%CI: 0.31 to 9.04). No association was observed between the different types of antibodies and APTT, resulting regression coefficients in 0.04 s (95%CI: -0.31 to 0.40) for cardiolipin IgG, 1.11 s (95%CI: -1.24 to 3.46) for IgM and -0.02 s (95%CI: -0.35 to 0.31) and 0,64 s (95%CI: -1.40 to 2.68) for antibeta 2 GPI, IgG and IgM, respectively. Conclusion: Given the results of our study we can not conclude that the elongation of APTT is related with the presence of antiphospholipids antibodies (AU)

Urgencias Pediátricas del Hospital Materno Infantil Gregorio Marañón / Pediatric Emergency Department of the Hospital Materno Infantil Gregorio Marañón

El presente documento refleja un resumen de la organización y actividad actual de la Unidad de Urgencias Pediátricas. Se describe la misión, visión y valores de la unidad. Se comenta la actividad asistencial, con la cartera de servicios, y las líneas de docencia e investigación. A continuación se expondrán las líneas estratégicas y de humanización ya emprendidas y futuras (AU)

This document summarizes the current organization and activity of the Pediatric Emergency Unit, describing its main mission, vision and values. The clinical assistance activities are described, including the services portfolio, and the teaching and research interests. Lastly, the document emphasizes the present and future directions of our humanization strategies (AU)

Asociación entre bronquiolitis moderada-grave y síndrome de secreción inadecuada de hormona antidiurética en urgencias / Association between moderate-severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments

OBJETIVOS: Identificar precozmente y analizar las características de pacientes que precisan ingreso por bronquiolitis moderada o grave que cumplen criterios urinarios de SIADH. PACIENTES Y MÉTODOS: Estudio prospectivo observacional, realizado entre octubre de 2012-marzo de 2013 en urgencias pediátricas. Se incluyen menores de 12 meses con bronquiolitis moderada o grave que requieren ingreso. Se consideran criterios urinarios de SIADH: sodio urinario≥40mmol/l, osmolaridad urinaria>500 mOsm/kg y densidad urinaria>1.020g/l. Se recogen variables epidemiológicas y clínicas y se comparan 2 grupos definidos por cumplir o no criterios urinarios de SIADH. RESULTADOS: Se incluyen 126 pacientes con bronquiolitis moderada, 23 (18,6%) cumplen criterios urinarios de SIADH, ninguno grave ni menor de un mes. Los pacientes con criterios urinarios de SIADH tienen mayor incidencia de neumonía y/o atelectasia en la radiografía de tórax (21,7% vs. 1,9%; p = 0,002), peor respuesta al tratamiento con adrenalina (69,5% vs. 28,1%; p = 0,016), mayor asistencia respiratoria: oxigenoterapia de alto flujo (17,4% vs. 7,7%; p = 0,016) y ventilación mecánica no invasiva (13% vs. 5,8%; p = 0,034). Requieren más días oxigenoterapia (p = 0,02) y tratamiento broncodilatador (p = 0,04) y mayor ingreso en cuidados intensivos pediátricos (26,1% vs. 6,8%; p = 0,007). CONCLUSIONES: Los pacientes mayores de 1 mes con bronquiolitis moderada y con criterios urinarios de SIADH tienen peor evolución respiratoria, mayor necesidad de soporte respiratorio, ingreso en UCIP y más alteraciones radiográficas. Por ello recomendamos realizar determinaciones de orina a estos pacientes para detectar precozmente el desarrollo de SIADH y cuidar el manejo hidroelectrolítico, previniendo el desarrollo de complicaciones potencialmente graves

OBJECTIVES: To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). PATIENTS AND METHODS: A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. RESULTS: A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). CONCLUSIONS: Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities

[Association between moderate-severe bronchiolitis and syndrome of inappropriate antidiuretic hormone secretion in emergency departments]. / Asociación entre bronquiolitis moderada-grave y síndrome de secreción inadecuada de hormona antidiurética en urgencias.

OBJECTIVES: To identify clinical characteristics that may lead to the early recognition of patients admitted to the hospital for moderate-to-severe bronchiolitis with urine results associated with the syndrome of inappropriate antidiuretic hormone secretion (SIADH). PATIENTS AND METHODS: A prospective observational study was conducted, spanning the bronchiolitis epidemic season (October 2012-March 2013), including all children who were admitted to the hospital with a diagnosis of moderate-to-severe bronchiolitis. The following criteria were used to establish a diagnosis of SIADH: urine sodium level of 40 mmol/L or greater, urine osmolarity above 500 mosm/Kg, and urine density of 1020 g/L or greater. Demographic characteristics, ventilation mode and clinical outcome were also analyzed. A comparison was made between those patients that met urine SIADH criteria and those who did not. RESULTS: A total of 126 children were included, and 23 (18.6%) of them had urine SIADH criteria. Patients in this group had a higher incidence of pneumonia and/or atelectasis on chest X-Ray (21.7% vs. 1.9%, P=.002), worse response to bronchodilator treatment with nebulized adrenaline (69,5% vs. 28,1%, P=.016), more need for respiratory assistance (high flow oxygen therapy (17.4% vs. 7.7%, p=.016), or non-invasive mechanical ventilation (13% vs. 5.8%, P=.034), and more admissions to the PICU (26.1% vs. 6.8%, P=.007). CONCLUSIONS: Patients older than one month with acute moderate bronchiolitis and urine SIADH criteria have worse clinical courses and more need for non-invasive mechanical ventilation, PICU admission, and have a higher incidence of pneumonia on chest X-ray. For that reason, it is recommended to collect a urine sample from these patients to allow an early diagnosis of SIADH, and thus early treatment of fluid and electrolyte abnormalities.

Utilidad de la procalcitonina en el diagnóstico precoz de apendicitis aguda / Usefulness of procalcitonin in early diagnosis of acute appendicitis

Introducción y objetivo: En los últimos años ha tratado de definirse la utilidad de los diferentes parámetros analíticos inflamatorios en el diagnóstico de la apendicitis aguda. El objetivo de este estudio es determinar el valor de la procalcitonina (PCT) en el diagnóstico precoz de esta entidad, comparándolo con los marcadores analíticos tradicionalmente solicitados en pacientes con dolor abdominal agudo (leucocitos/proteína C reactiva). Método: Estudio prospectivo analítico, durante el periodo comprendido entre julio y diciembre de 2011. Se incluyeron menores de 16 años con dolor abdominal y sospecha clínica de apendicitis. Se procedió al estudio de las variables analíticas (leucocitos, proteína C reactiva [PCR], PCT) y la elaboración de una curva ROC para los parámetros de laboratorio evaluados. Resultados: Se incluyeron 105 pacientes con una media de edad de 10,2 años (±3,3). El diagnóstico de apendicitis se confirmó por histología en el 39% (41/105), clasificándose el 42,5% como apendicitis perforada y el 11,5% como gangrenada. La cifra media de leucocitos fue significativamente mayor en el grupo con apendicitis (15,143/µL frente a 10,723/µL; p <0,001), al igual que el valor de la mediana de PCT (1,4 µg/L [rango: 0,7-6,1] frente a 0,6 µg/L [rango: 0,5-1,8]; p <0,05). El área bajo la curva ROC para la cifra de leucocitos fue de 0,76; los valores obtenidos para la PCR (0,63) y la PCT (0,6) fueron inferiores. La mayoría de los pacientes (94/105), así como los diagnosticados de apendicitis (31/41), mostraron valores de PCT normales. No obstante, el diagnóstico de apendicitis se confirmó en todos los que presentaron un aumento de la PCT, excepto en 2. Todas las apendicitis gangrenadas presentaron una elevación de la PCT. Conclusiones: La PCT no es un buen marcador precoz de apendicitis. No obstante, su elevación actúa como factor predictivo en el diagnóstico de apendicitis y su grado de evolución (AU)

Introduction and objective: Recent studies have tried to define the usefulness of different inflammatory laboratory parameters in the diagnosis of acute appendicitis. The objective of this study is to determine the value of procalcitonin (PCT) in the early diagnosis of this entity, compared with traditional laboratory markers in patients with acute abdominal pain (WBC/CRP). Methods: Prospective analytical study. Period: July to December 2011. Inclusion of children under 16 years with abdominal pain and clinical suspicion of appendicitis. Analytical analysis (leukocytes, CRP, PCT) and development of a ROC curve for laboratory parameters evaluated. Results: We included 105 patients with a mean age 10.2 years (± 3.3). The diagnosis of appendicitis was confirmed by histology in 39% (41/105), 42.5% of them were classified as perforated appendicitis and 11.5% as gangrenous. The average number of leukocytes was significantly higher in the group with appendicitis (15.143/μL vs 10.723/μL; p <0.001), like the median value of PCT (1.4 µg/L [0.7 to 6.1] vs 0.6 µg/L [0.5 to 1.8]; p <0.05). The area under the ROC curve for leukocyte count was 0.76; the values obtained for the PCR (0.63) and PCT (0.6) were lower. The majority of patients (94/105) and those diagnosed of appendicitis (31/41) showed normal PCT values. The diagnosis of appendicitis was confirmed in those with increased PCT, but 2. All patients with gangrenous appendicitis had elevation of PCT. Conclusions: PCT is not a good early marker of appendicitis. However, his elevation acts as a predictor for the diagnosis of appendicitis and its degree of evolution (AU)

[Partial bilateral agenesis of the posterior arch of the atlas]. / Agenesia parcial bilateral del arco posterior del atlas.

INTRODUCTION: Congenital abnormalities of the posterior arch of the atlas (C-1) are very uncommon and not widely known. Isolated partial agenesis of the posterior arch of the atlas was initially considered a benign variation without any clinical or pathological significance. There is, however, increasing evidence that neurological symptoms may occur after minor cervical trauma in patients with an isolated partial agenesis of the posterior arch of the atlas, specially the types 'C' and 'D' malformations described by Currarino et al. CLINICAL CASE: A 63 year old woman with cervicalgia and 'seasickness', was study with a plain cervical spine radiographs and CT with three-dimensional reconstruction, who showed a bilateral partial absence of the posterior arch of C-1 with persistent posterior tubercle, corresponded to type 'D' in the classification descrites by Currarino et al. CONCLUSIONS: The fact of this pathology can unchain an important neurological symptoms after minor cervical trauma, oblige to the physician (radiologist, neurologist, neurosurgeon, traumatologist, rehabilitation specialist) know this pathology, for to include this patients in a group of the risk, and indicate to them who should avoid contact sports and other strenuous athletic endeavors, and furthermore value the surgical treatment.