Ponticulus posticus upon routine evaluation of cervical spine x-ray in head injury patient: Case reports

Abstract

Introduction: Ponticulus posticus or known as foramen arcuate is an anatomic variation of the first cervical vertebra origin from calcification of the posterior atlantooccipital membrane. The vertebral artery passes through this canal. This canal can be complete or incomplete and can also be unilateral or bilateral. Often related to symptoms of headaches, vertebrobasilar insufficiency, or acute hearing loss. Whereas, imaging studies show the presence of a partial osseous bridge on the upper surface of the atlas. This study aimed to present two cases of ponticulus posticus in head injury patients. Case presentation: We reported 2 cases of ponticulus posticus found incidentally in head injury patients at our institution. The patients were managed conservatively for 5 days and sent home with no neurological deficit and complication. Conclusion: Ponticulus posticus is often ruled out in pre-admission screening. Neurosurgeons should consider this to predict the neurological deficit.