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Atlanto-occipital dislocation: case report and discussion

Published online by Cambridge University Press:  21 May 2015

David A. McKenna ,
Clare J. Roche ,
W. Kit Lee ,
William C. Torreggiani  and
Vinay A. Duddalwar
David A. McKenna*
Affiliation:
Department of Radiology, University College Hospital Galway, Newcastle, Galway City, County Galway, Ireland
Clare J. Roche
Affiliation:
Department of Radiology, University College Hospital Galway, Newcastle, Galway City, County Galway, Ireland
W. Kit Lee
Affiliation:
Department of Radiology, Vancouver General Hospital, Vancouver, BC
William C. Torreggiani
Affiliation:
Department of Radiology, Vancouver General Hospital, Vancouver, BC
Vinay A. Duddalwar
Affiliation:
Department of Radiology, Vancouver General Hospital, Vancouver, BC
*
Department of Radiology, University College Hospital Galway, Newcastle Road, Galway City, Republic of Ireland; tel 00-353-91-524222, fax 00-353-91-521197, radiologyresident@hotmail.com

Abstract

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Atlanto-occipital dislocation (AOD) is a devastating condition that frequently results in prehospital cardiorespiratory arrest and accounts for 15% of fatal spinal trauma. Atlanto-occipital dislocation occurs 5 times more commonly in children than adults, and is believed to be caused by hyperextension. Because of improvements in prehospital resuscitation, more victims with AOD now survive to reach the emergency department. Neurologic injury is usually severe secondary to ligamentous disruption that allows the cranium to move with respect to the cervical spine, and associated facial and head injuries are common. There are, however, reports of survivors without neurologic deficits. We present the case of a 46-year-old woman who suffered an AOD after a motor vehicle crash and we discuss the diagnosis of this condition. The signs of AOD are often subtle, and the possibility of this diagnosis must be kept in mind in all patients with a neck injury, even in the absence of neurologic signs. A systematic approach to assessing the cranio-cervical relationship on the lateral cervical x-ray and the appropriate use of CT scanning is essential to identifying AOD. Through this case report we hope to familiarize clinicians with mechanisms of injury and appropriate imaging interpretation that will assist in the diagnosis of AOD.

Keywords

atlanto-occipital dislocationspinal traumaneurologic injurydiagnosis of AOD
Type
Case Report • Observations de cas
Information
Canadian Journal of Emergency Medicine , Volume 8 , Issue 1 , January 2006 , pp. 50 - 53
Copyright
Copyright © Canadian Association of Emergency Physicians 2006

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