Until recently, it was uncommon to treat this kind of injury, since patients usually would die at the scene of the accident or promptly upon arrival to the hospital, due to fatal brain stem injury. Aggressive resuscitative efforts at the scene have converted AOD into a potentially survivable injury. The associated morbidity and mortality with missed AOD are quite high, and a high index of clinical suspicion must always be considered. This injury is highly unstable, with the potential for neurological worsening.
A pedestrian struck by a car is a common clinical scenario. Distraction forces are thought to be responsible for the injury to the ligaments that provide stability to this region. Clinically, patients can present with complete tetraplegia and respiratory distress or may be neurologi-cally normal. Sometimes, complaints of occipital pain can be voiced by the conscious patient and lower cranial nerve palsies can be detected. The Brown-Sequard, central cord or Bell's cru-tiate paralysis syndromes have been described with this injury.
Plain lateral radiographs will show an increased distance between the clivus and the tip of the dens. Displacement of the skull relative to the spine either anteriorly (type I AOD) or posteriorly (type III AOD) can also be seen. Type II AOD consists of a longitudinal distraction separating the occiput from the atlas
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The term vaginitis is one that is applied to any inflammation or infection of the vagina, and there are many different conditions that are categorized together under this ‘broad’ heading, including bacterial vaginosis, trichomoniasis and non-infectious vaginitis.