Atlas shrugged: cervical myelopathy caused by congenital atlantoaxial dislocation aggravated by child labor.
BACKGROUND
Symptomatic atlantoaxial dislocation is common in predisposing genetic or acquired disorders. However, an isolated atlantoaxial dislocation frequently is congenital and silent unless discovered during course of evaluation for neurological symptoms of cervical spinal cord injury attributed to minor or chronic, repetitive trauma.


METHODS
A 12-year-old girl working as a farm laborer developed calf pain provoked by walking, which increased in severity and progressed to involve the upper limbs. It was followed by progressive ascending quadriplegia. The illness resembled acute inflammatory demyelinating polyneuropathy with respiratory involvement. Presence of "claw" hands bilaterally and wasting of intrinsic muscles of the hands led to the suspicion of a cervical myelopathy.


RESULTS
Neuroimaging confirmed a congenital atlantoaxial dislocation with basilar invagination. The absence of abnormal signals in the cervical spinal cord was unusual. The symptomatic congenital atlantoaxial dislocation was postulated to be precipitated by chronic trauma suffered while habitually carrying heavy loads on the head and leading to spinal cord injury without radiographic abnormalities. Correction via surgery was successful.


CONCLUSIONS
Congenital atlantoaxial dislocation should be suspected in a clinical setting of neurological symptoms of cervical spinal cord injury without obvious trauma or predisposing primary diseases. Prompt cervical spine imaging reveals the correct diagnosis. Physicians in countries in which child labor is rampant should be aware of the potential complications of cervical cord injuries from child labor.
Department of Pediatrics, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, India.
Roneil N
RN
Parikh
Department of Pediatrics, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, India. Electronic address: muranjanmamta@gmail.com.
Mamta
M
Muranjan
Department of Pediatrics, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, India.
Sunil
S
Karande
Department of Radiology, Seth Gordhandas Sunderdas Medical College and King Edward VII Memorial Hospital, Parel, Mumbai, India.
Shilpa
S
Sankhe
D000383:Agriculture; D001268:Atlanto-Axial Joint / Q000002:abnormalities* / Q000473:pathology; D002574:Cervical Vertebrae / Q000473:pathology / Q000601:surgery; D002648:Child; D004651:Employment; D005260:Female; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000151:congenital* / Q000473:pathology; D008279:Magnetic Resonance Imaging; D011782:Quadriplegia / Q000209:etiology / Q000473:pathology; D013118:Spinal Cord Diseases / Q000209:etiology* / Q000473:pathology / Q000601:surgery; D014057:Tomography, X-Ray Computed
basilar invagination; congenital atlantoaxial dislocation; craniovertebral junction; quadriplegia; spinal cord injury without radiographic abnormalities (SCIWORA)