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Year : 2016  |  Volume : 14  |  Issue : 4  |  Page : 132-133

CME in Images

Department of Continuing Medical Education, Christian Medical College, Vellore, Tamil Nadu, India

Date of Web Publication22-Nov-2016

Correspondence Address:
Tony Abraham Thomas
Christian Medical College, Vellore - 632 002, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0973-4651.194479

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How to cite this article:
Thomas TA. CME in Images. Curr Med Issues 2016;14:132-3

How to cite this URL:
Thomas TA. CME in Images. Curr Med Issues [serial online] 2016 [cited 2022 May 24];14:132-3. Available from: https://www.cmijournal.org/text.asp?2016/14/4/132/194479

  Case Scenario Top

A 5-year-old boy with a history of mild mental retardation complained of difficulty in running and holding objects with his hands for 2 weeks. One examination, there were dysmorphic facial features, his head was slightly tilted to one side, and deep tendon reflexes were exaggerated in all the limbs. On further questioning, there was a history of a fall from a wall 1 month before onset of symptoms. An X-ray of the hands and magnetic resonance imaging (MRI) and three-dimensional reconstruction computerized tomography (CT) of the cervical spine are seen in [Figure 1] and [Figure 2].
Figure 1: X-ray radiograph of the both hands

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Figure 2: (a) Computerized tomography of the cervical spine with three-dimensional reconstruction. (b) Magnetic resonance imaging of the cervical spine

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  Questions Top

  1. What are the findings in the images?
  2. What is the possible diagnosis from the clinical scenario and radiological images?
  3. Why did the child develop neurological dysfunction?

  Answers Top

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A child with Down's syndrome has lax ligaments and a higher incidence of vertebral anomalies when compared with normal children. Hence, there should be a higher suspicion of spinal cord injury after trauma in these individuals. Following an injury, the attending physician must closely examine the patient for signs and symptoms of neurological dysfunction and if present, a cervical collar must be applied and referred to a neurosurgeon immediately.

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Conflicts of interest

There are no conflicts of interest.

  References Top

Benacerraf BR, Harlow BL, Frigoletto FD Jr. Hypoplasia of the middle phalanx of the fifth digit. A feature of the second trimester fetus with Down′s syndrome. J Ultrasound Med 1990;9:389-94.  Back to cited text no. 1
Hreidarsson S, Magram G, Singer H. Symptomatic atlantoaxial dislocation in Down syndrome. Pediatrics 1982;69:568-71.  Back to cited text no. 2
Pueschel SM, Scola FH. Atlantoaxial instability in individuals with Down syndrome: Epidemiologic, radiographic, and clinical studies. Pediatrics 1987;80:555-60.  Back to cited text no. 3
Bull MJ; Committee on Genetics. Health supervision for children with Down syndrome. Pediatrics 2011;128:393-406.  Back to cited text no. 4
Ostermaier KK. Down syndrome: Management. Uptodate. Available from: http://www.uptodate.com/contents/down-syndrome-management. [Last accessed on 2016 Oct 31].  Back to cited text no. 5


  [Figure 1], [Figure 2]


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