Craniovertebral malformation complex in a child with Weismann-Netter-Stuhl syndrome.
OBJECTIVE
Bowing of the legs is usually thrown into the basket of vitamin D deficiency rickets; therefore, a significant number of affected children can be misdiagnosed and improperly managed. This case illustrates how the careful clinical and radiological assessment of such a case can lead to the adequate understanding of its etiology.


METHODS
We report a sporadic case of a 2-year-old male child who presented with radiological features that were compatible with Weismann-Netter-Stuhl syndrome. In addition, we observed craniovertebral malformation complex. He was of normal intelligence. To our knowledge, the combination of Weismann-Netter-Stuhl syndrome and presence of a hypoplastic occipitalized atlas and further C2-C3 fusion has not been reported before. The diagnosis of Weismann-Netter-Stuhl is discussed. Classically, Weismann-Netter-Stuhl syndrome is characterized by short stature, mental retardation (in some individuals), dural calcification, and anterior bowing of the tibiae. However, we believe that careful clinical and radiological examinations can reveal more striking data which might positively reflect on the whole process of management.


CONCLUSIONS
We postulate that the congenital limitations in neck movements in our patient developed because of the marked fusion of the hypoplastic and occipitalized atlas and simultaneous C2-C3 fusion. Therefore, if this form of malformation is disregarded, there may be involvement of the atlantoaxial structure, and this can possibly lead to serious neurological and even life-threatening complications. The use of CT scanning for the detection of such abnormalities can be remarkably important.
Al Kaissi
Ali
A
Ludwig-Boltzmann Institute of Osteology, Hanusch Hospital of WGKK and AUVA Trauma Centre Meidling, 4th Medical Department, Vienna, Austria. ali.alkaissi@osteologie.at
Ben Chehida
Farid
F
Gharbi
Hassan
H
Jinziri
Mourad
M
Safi
Hatem
H
Ben Ghachem
Maher
M
Grill
Franz
F
Varga
Franz
F
Klaushofer
Klaus
K
D000015:Abnormalities, Multiple / Q000000981:diagnostic imaging* / Q000209:etiology; D001268:Atlanto-Axial Joint / Q000002:abnormalities*; D002675:Child, Preschool; D005360:Fibula / Q000002:abnormalities; D006801:Humans; D007870:Leg Length Inequality / Q000000981:diagnostic imaging* / Q000209:etiology; D008297:Male; D009139:Musculoskeletal Abnormalities / Q000000981:diagnostic imaging*; D012886:Skull / Q000002:abnormalities*; D013577:Syndrome; D014057:Tomography, X-Ray Computed; D014808:Vitamin D Deficiency / Q000150:complications