ATLANTOOCCIPITAL SUBLUXATION IN A NEONATE WITH DOWNS-SYNDROME - CASE-REPORT AND REVIEW OF THE LITERATURE

Atlantooccipital subluxation (AOS) occurs in up to 63% of patients wit h Down's syndrome. However, presenting symptoms and the age at which p reoperative screening becomes necessary have not been clearly delineat ed. Recently, a 16-day-old female with Down's syndrome and AOS present ed to our institution. Following patent ductus arteriosus ligation, he r neurological examination revealed trace movement, few spontaneous re spirations, and left lower extremity clonus. Cervical spine radiograph s revealed significant AOS. She was reduced and underwent a fusion fro m the occiput to C2. She gradually regained full strength and sensatio n. This case is the youngest example of AOS related to Down's syndrome described. It emphasizes the need for preoperative screening of all p atients with Down's syndrome.