Bell's Cruciate Paralysis in Type II Odontoid Fracture: Case Report
American Journal of Physical Medicine and Rehabilitation
Case Diagnosis: Bell's Cruciate Paralysis
Case Description: We report a 23-year-old man sustained Type II odontoid fracture with mild anterior displacement and a comminuted displaced fracture along the anterior arch of C1. He underwent posterior cervical fusion of C1-C2. Post op he failed extubation trials eventually requiring Tracheostomy and G tube placement. Once medically stabilized he was transferred to in-patient rehabilitation to address his spinal cord injury rehabilitation issues. His clinical and ASIA exam was completed. It showed questionable facial nerve palsy and upper extremity weakness with minimal or no involvement of the lower extremities that is consistent with Bell's Cruciate Paralysis. His spasticity, neurogenic bowel and bladder was optimized. Prognosis with his functional status was addressed along with a safe discharge plan.
Discussions: Bell's Cruciate Paralysis is a rare incomplete spinal cord syndrome presenting as upper extremity weakness with minimal or no involvement of the lower extremities. Cranial nerves can be compromised. It usually occurs due to trauma to the axis and/or atlas.
Clinical presentation as well as magnetic resonance imaging (MRI) can aid in confirming the diagnosis. Physiatry involvement is vital to facilitate the rehabilitation plan and ensure optimal recovery. Prognosis is usually good and depends on the extent of spinal cord injury and the exact cause.
Conclusions: Cruciate Paralysis is an important cause of brachial diplegia and must be differentiated from acute Central Cord syndrome which can have similar clinical features. Cranial nerve injury can be involved. This report illustrates the significance of Physiatry involvement in high spinal cord injuries and the ability to detect rare injuries and ensure adequate and appropriate management in a timely manner.
Al Lawati ZJ, Smith R. Bell's cruciate paralysis in type II odontoid fracture: case report. Am J Phys Med Rehab. 2021;100(4 suppl.):a37.