Frequency of Ponticulus posticus and Ponticulus lateralis in patients admitted to hospital with traumatic brain injur

Abstract

To determine the frequency of Ponticulus posticus and Ponticulus lateralis among patients admitted to a24-hour emergency hospital. The study included 2887 patients with a traumatic history who were admitted to the hospital for emergency reasons. This principle of sampling allowed us to exclude a high concentration of studies of patients with chronic neurological diseases, the cause of which could be symptomatic Kimmerle's anomaly (KA). During the period 01.01.20 to 31.12.20, primary CT was performed on an emergency basis in 7348 patients. Of these, CT scans of the brain and cervical spine were performed in 2965 patients. Some patients (78 people) were excluded from the study due to the presence of cervical vertebral fractures and metal artifacts in the craniovertebral region. The Ponticulus posticus was detected in 1162 (40.2%) patients, among them class 3 and 4 was detected in 27.7%, and class 2 ossification in 12.5%. This Ponticulus posticus was significantly more common (χ2 test, p=0.0005) in men. The Ponticulus lateralis was identified in 231 patients (8%), among them 94 patients (3.3%) had complete ponticulus on both sides, 29 patients (1%) - on one side, and 108 patients (3.7%) - two-sided incomplete ponticulus. In patients with class 2-3-4, Ponticulus lateralis were detected significantly more often (χ2 test, p<0.0001). The cumulative incidence of KA was 42%, 17% of patients are carriers of a complete KA bridge, which is significantly higher than in the European or Asian regions. The data suggest that KA is not the result of ossification of the posterior atlanto-occipital membrane, since different classes of KA occur equally often at different ages. Further studies of KA are needed, including its occurrence in patients of the neurological department and its correlation with individual neurological syndromes to determine the need for surgical treatment in the population.