Kimmerle Anomaly and Drop Attacks in Adolescent

Enrico Finale; Mauro Martinetti; Fabrizio La Rocca; Fulvio Guccione; Andrea Guala

doi:10.12691/ajmcr-3-8-9

American Journal of Medical Case Reports

Vol. 3, No. 8, 2015, pp 255-256. doi: 10.12691/ajmcr-3-8-9 | Case Report

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Kimmerle Anomaly and Drop Attacks in Adolescent

Enrico Finale¹, Mauro Martinetti², Fabrizio La Rocca³, Fulvio Guccione⁴, Andrea Guala^5,

¹Department of Obstetrics and Gynecology, Castelli Hospital, Italy

²Department of Radiology, Castelli Hospital Verbania, Italy

³Department of Pediatric Neurology, Castelli Hospital Verbania, Italy

⁴Department of Pediatric Neurology, ASL Novara, Italy

⁵Department of Pediatrics and Neonatology Castelli Hospital Verbania, Italy

	Abstract
1.	Introduction
2.	Discussion
3.	Conclusion
	References

Abstract

A. is 12 years old and comes to the first aid for a fainting spell during gym class. Pediatric and Neurological examination, ECG, EEG and RMN are all negatives. The medical history is negative regarding the main causes of Drop Attacks. Only one cervicodorsal radiography allows diagnosis of Kimmerly’s anomaly. The Kimmerly’s anomaly occurs in adults in 14% of the population, but is extremely rare in adolescents. The conduct adopted, after discussion with the neurologist and neurosurgeon, is waiting and symptoms monitoring.

Keywords: drop attacks, Kimmerle anomaly

Received July 09, 2015; Revised July 15, 2015; Accepted July 17, 2015

Cite this article:

Enrico Finale, Mauro Martinetti, Fabrizio La Rocca, Fulvio Guccione, Andrea Guala. Kimmerle Anomaly and Drop Attacks in Adolescent. American Journal of Medical Case Reports. Vol. 3, No. 8, 2015, pp 255-256. https://pubs.sciepub.com/ajmcr/3/8/9

Finale, Enrico, et al. "Kimmerle Anomaly and Drop Attacks in Adolescent." American Journal of Medical Case Reports 3.8 (2015): 255-256.

Finale, E. , Martinetti, M. , Rocca, F. L. , Guccione, F. , & Guala, A. (2015). Kimmerle Anomaly and Drop Attacks in Adolescent. American Journal of Medical Case Reports, 3(8), 255-256.

Finale, Enrico, Mauro Martinetti, Fabrizio La Rocca, Fulvio Guccione, and Andrea Guala. "Kimmerle Anomaly and Drop Attacks in Adolescent." American Journal of Medical Case Reports 3, no. 8 (2015): 255-256.

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1. Introduction

A. is 12 years old and she’s always been good. She started a gymnastic course, organised by her school. She arrived to the first aid, because during an exercise she fells to the ground; her legs gave way; She did not lose knowledge, she feels tingling, headache and after few minutes her legs have recovered strength and she started walking.

The same episode happened some times in the last weeks but today the gymnastic teacher wos worried and she colled as parents.

2. Discussion

The examination and neurological examination are normal. According to the stories, we can imagine that a falls to the ground when she rotates the head and when she moves her arms back in hyperextension.

Then began a depth about the “drop attaks” or sudden fall to the ground and possible differential diagnoses (Table 1).

Table 1.

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Pediatric and neurological visits, electroencephalogram, electrocardiogram and then 24 hours holter, tilt test, echocardiogram, doppler ultrasound of neck vessels and RMN are all negatives.

We think is a cervical accessory rib but the radiography of the cervicodorsal don’t shows are not even mega apophysis transverse; it is highlighted instead a Kimmerle’s anomaly (Figure 1).

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Figure 1. Kimmerle anomaly

The vertebral artery passes near the posterior arch of the atlas, and impressing a groove in the bone. If the fibrous ligament of the condyle is ossifies, the groove can transform in a hole-channel, this determining an entrapment of the vertebral artery whit the venous plexus and the suboccipital nerve ^[1]. This anomaly is not uncommon in the adults (14% of the population) and usually is asymptomatic, but sometimes is associated a headache crisis, deafness, dizziness, paresthesia and drop attaks ^{[2, 3]}. The ligament ossification is moreover very uncommon in the childhood.

3. Conclusion

After tolking whit the neurologist and neurosurgeon it was decided to wait. Although thay have been reported pediatric cases of stroke by stretching of the vertebral artery in the arcuate foramen and dissection by repetitive neck trauma ^{[4, 5]}.

References

[1]	Prakash BS et al. “Left arteriae vertebralis canal in atlas-Kimmerle anomaly” Int J Anatom Variat 3:130, 2010.
	In article

[2]	Koutsouraki E. et al. “Kimmerle’s anomaly as a causative factor of chronic tension headaches and neurosensory hearing loss”. Encephalos 47:150, 2010.
	In article

[3]	Split W. et al. “Clinical symptoms and signs in Kimmerle anomaly” Wlad Lek 55:416, 2002.
	In article

[4]	Eliott RE, Tanweer O. “The prevalence of the arcuate foramen and its importance” World Neurosurg 82:335, 2014.
	In article

[5]	Cusching KE et al. “Tethering of the vertebral artery in the congenital arcuate foramen of the atlas vertebra: a possible cause of vertebral artery dissection in children” Dev Med Child Neurol 43:491, 2001.
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