A Case of Traumatic Vertical Atlanto-occipital Dislocation

Abstract

Advances in both critical care medicine and diagnostic imaging have allowed increased recognition of traumatic atlanto-occipital dislocation(AOD) . AOD is often overlooked due to severe coexistent complications, and even in cases with mild concomitant complications, AOD may be overlooked because of its anatomical specificity. Here we report a case of traumatic AOD in a 38-yearold woman. She had fallen from the 4th floor of a building and was unconscious on arrival at the hospital, with a Glasgow Coma Scale score of E1V1M1. In the emergency ward, a chest drain was inserted for left traumatic hemopneumothorax. After her vital signs had stabilized, clinical and radiological workups revealed traumatic AOD with subarachnoid hemorrhage at the craniocervical junction. Furthermore, multiple rib fractures, traumatic aortic dissection, T10 burst fracture, and dislocation of the temporomandibular joint were diagnosed. After intensive care treatment, the patient regained consciousness and could move her limbs fully except for the left deltoid muscle(manual muscle test, 4/5) . Fixation was performed for the ribs and thoracic burst fracture before occipital-C2 fusion. She was able to walk and manage all activities of daily living after 2 months of clinical treatment and rehabilitation. As emergency medicine and care continue to develop, survival after AOD will increase, meaning that immediate and appropriate diagnosis and treatment will be increasingly important. Traumatic subarachnoid hemorrhage at the craniocervical junction is often complicated by AOD. This is important to keep in mind for doctors who do not specialize in pathologies of the spinal cord.