title: [Injuries to the upper cervical medulla in severe brain injuries].
abstract: BACKGROUND
  Cranial magnetic resonance imaging (MRI) was performed in 250 patients who had been unconscious post-trauma for at least 24 hours. The frequency and the characteristics of injuries to the upper cervical myelon were determined.
  
  
  METHODS
  Between 1996 and 2009, MRI was carried out within 8 days of trauma.
  
  
  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. (i) 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. (ii) 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
  Two types of lesions involving the upper cervical myelon could be differentiated, both of which occur only in association with lesions in the medulla oblongata.
authors: Neurochirurgie, Klinikum Landshut. dieter.woischneck@klinikum-landshut.de
authors: D
authors: D
authors: Woischneck
authors: T
authors: T
authors: Kapapa
authors: C
authors: C
authors: Grimm
authors: M
authors: M
authors: Skalej
authors: B
authors: B
authors: Schmitz
authors: N
authors: N
authors: Blumstein
authors: R
authors: R
authors: Firsching
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001926:Brain Death / Q000175:diagnosis / Q000473:pathology; D001930:Brain Injuries / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology / Q000601:surgery; D001933:Brain Stem / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D002574:Cervical Vertebrae / Q000293:injuries / Q000473:pathology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007223:Infant; D008279:Magnetic Resonance Imaging; D008297:Male; D008526:Medulla Oblongata / Q000293:injuries* / Q000473:pathology / Q000601:surgery; D008875:Middle Aged; D011379:Prognosis; D011782:Quadriplegia / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D019291:Skull Base / Q000293:injuries / Q000473:pathology / Q000601:surgery; D013119:Spinal Cord Injuries / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D020206:Subarachnoid Hemorrhage, Traumatic / Q000175:diagnosis / Q000401:mortality / Q000473:pathology / Q000601:surgery; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D055815:Young Adult