Grisel Syndrome in Adult Patients. Report of Two Cases and Review of the Literature
Bibliographic record
Abstract
Grisel's syndrome involves the subluxation of the atlantoaxial joint from inflammatory ligamentous laxity following an infectious process in the head or neck 1 .It rarely occurs in adults.In children, the treatment is first medical with the need for immobilization and sometimes internal fixation depending on the stability of C1-C2.In this paper we report two cases of Grisel syndrome in adults. CASE REPORT Case 1A 50-year-old female intravenous drug user presented with neck pain and electrical sensations in the upper and lower limbs on neck flexion (Lhermitte's sign).There was no history of head and neck trauma but she reported tonsilopharyngitis one to two weeks prior to consultation.Her physical examination was normal except for a positive Lhermitte's sign.Magnetic resonance imaging (MRI) of the cervical spine revealed a mass infiltrating the posterior subligamentous region of the anterior arch of C1, the odontoid and the body of C2 and compressing the bulbo-medullary junction (Figure 1).and an increase of the atlanto-dental interval (Figure 2).The CT-scan did not show any bony destruction or a rotatory subluxation (Figure 3).The patient received antibiotics with wide spectrum coverage and was stabilized in a Halo vest after closed reduction.The radiological follow-up revealed a decrease in the prevertebral collection as well as a decrease in the spinal cord compression (Figure 4 and 5).After three months the patient fell and presented to the emergency room with loosening of the Halo.She was neurologically intact but the flexion cervical x-ray revealed a C1-C2 instability (Figure 6).The patient underwent a C1/C2 fusion, with C1 lateral mass screw and a pars screw (Figure 7).At her last follow-up (five months), the patient was doing very well and was pain-free.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.001 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.004 | 0.003 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.002 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".