Comprehensive and integrated management of basilar impression, platybasia and cranio-vertebral junction abnormality- a case report

Platybasia is a developmental defect of the occipital bone and upper cervical spine resulting from anomalous development. The mechanism of such anomaly is not known however the most accepted theory includes abnormal basi-occiput development. It tends to produce marked pressure effects on the brain stem and cervical vertebrae. These pressure effects may present as signs similar to progressive spastic paralysis, cerebellar symptoms or cranial nerve palsy besides musculoskeletal symptoms. It is, therefore, crucial for physicians and radiologists to be familiar with clinical manifestations and radiological findings. In the following case of a patient with base of skull anomalies, surgical intervention in view of progressive worsening of motor symptoms was advised, however the guardians declined the same due to high risk involved. Due to financial constraints, genetic study was unaffordable and lack of awareness regarding the disease hampered the guardians from making a decision on definite management of the disease. In cases as presented below, surgical reconstruction of the foramen magnum and upper cervical spinal canal may be considered. Besides a radical neurosurgery, intensive physiotherapy can prove vital in to significantly improve the quality of life for the patient.