1998 Volume 12 Issue 1 Pages 49-56
We report a case of cruciate paralysis with a Jefferson's fracture and atlanto-occipital dislocation. A58-year-old man was referred to our hospital because of an accidental fall. At the neurological examination, a bilateral motor deficit was observed in the upper limbs, but the lower limbs did not appear to be affected. Left lower cranial nerves (IX, X, XII) dysfunction were noted. Three-dimensional CT of the cervical spine demonstrated an atlanto-occipital dislocation. MRI showed that the medullocervical junction was squeezed between the occipital bone and the axis. The patient was treated using a halo vest and, about three months later, he was treated by occipitocervical fusion. About one month after the operation, he was discharged from our hospital without any neurological deficits. Cruciate paralysis is an uncommon injury at the medullo-cervical junction. It was characterized by weakness of the upper extremities and with minimal or no lower extremity involvement. It was caused by focal and reversible damage of the pyramidal tract at the level of the decussation. About thirty cases of cruciate paralysis have been reported in the literature that were reviewed.
