title: Tonsillar contusion associated with benign tonsillar ectopia following minor head trauma.
abstract: OBJECTIVE
  The relationship between tonsil position and symptomatic cerebellar contusion is unclear. To date, there are no reports of symptomatic traumatic brain injury associated with benign tonsillar ectopia. Reported cases are limited to prominent cerebellar tonsillar displacement by ≥5 mm (i.e., Chiari malformations).
  
  
  METHODS
  The authors describe a case of symptomatic concussion in a toddler with unusual computerized tomography (CT) presentation and incidental finding of benign tonsillar ectopia, hemorrhagic contusion of the tonsils, blood-brain barrier (BBB) disruption and delayed atrophy shown using magnetic resonance imaging (MRI) studies. The radiological presentation and the clinical challenges are discussed through a review of the literature.
  
  
  CONCLUSIONS
  This case suggests that damage to cerebellar structures is not limited only to overt tonsillar herniation. Benign tonsillar ectopia may predispose to cerebellar contusion even after minor concussion and thus has a clinical significance. The current paradigm viewing only noticeable tonsillar herniation as a risk factor for hindbrain injury should be revisited.
authors.affiliation: The Laboratory for Experimental Neurosurgery, Department of Physiology and Cell Biology, Zlotowski Center for Neuroscience, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel. serliny@post.bgu.ac.il.
authors.forename: Yonatan
authors.initials: Y
authors.lastname: Serlin
authors.affiliation: Department of Neurosurgery, Hadassah-Hebrew University Medical Center, P.O. Box 12000, Jerusalem, 91120, Israel.
authors.forename: Mony
authors.initials: M
authors.lastname: Benifla
authors.affiliation: Department of Radiology, Soroka Medical Center, Ben-Gurion University of the Negev, Beer-Sheva, 8410501, Israel.
authors.forename: Ilan
authors.initials: I
authors.lastname: Shelef
mesh_terms: D001924:Brain Concussion / Q000150:complications* / Q000000981:diagnostic imaging; D002526:Cerebellar Diseases / Q000000981:diagnostic imaging / Q000209:etiology*; D002531:Cerebellum / Q000000981:diagnostic imaging*; D002675:Child, Preschool; D004677:Encephalocele / Q000000981:diagnostic imaging / Q000209:etiology*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging
keywords: Blood-brain barrier; Chiari malformation; Concussion; Contusion; Herniation; Tonsillar ectopia