Atlanto-occipital dislocation: Case report and discussion

Abstract

Traumatic atlanto-occipital dislocation is an uncommon injury that frequently results in either a fatal outcome or severe neurologic deficit. This diagnosis must be considered for any patients who may have had cervical spine damage after high trauma, even in the absence of neurologic signs, as there have been reports of cases without neurologic impairment. In addition to radiographic examination, including lateral cervical radiographs, supplemental imaging with CT or MRI may be required to confirm diagnosis in equivocal cases, and to help in evaluation of bone and nervous structures. Moreover, these modalities allow measurement of the magnitude of dislocation and aid in classification of type of dislocation, which helps guide management. A systematic approach to evaluating the cranio-cervical relationship is critical to identifying atlanto-occipital dislocation. This case report presents and discusses imaging findings that will assist in the diagnosis of atlanto-occipital dislocation.

Keywords: AOD, atlanto-occipital dislocation; CT, computed tomography; MRI, magnetic resonance imaging.

Figure 1

CT image (reformatted in the coronal plane) shows dislocation of both atlanto-occipital joints.

Figure 2

Computed tomography images reformatted in the sagittal plane show dislocation of the A) right and B) left atlanto-occipital joints.

Figure 3

Coronally reformatted CT movie file showing bilateral dislocation of both atlanto-occipital joints.

Figure 4

Sagittally reformatted CT movie file showing bilateral dislocation of both atlanto-occipital joints.