Traumatic Atlanto-Occipital Dislocation Presenting With Dysphagia as the Chief Complaint: A Case Report

Abstract

We report a patient with traumatic atlanto-occipital dislocation who presented with dysphagia as the chief complaint. A 59-year-old man complained of swallowing difficulty for 2 months after trauma to the neck. On physical examination, there was atrophy of the right sternocleidomastoid and upper trapezius muscles, and the tongue was deviated to the right. In a videofluoroscopic swallowing study, penetration and aspiration were not seen, food residue remained in the right vallecula and pyriform sinus, and there was decreased motion of the soft palate, pharynx and larynx. Electromyography confirmed a right spinal accessory nerve lesion. Magnetic resonance imaging confirmed atlanto-occipital dislocation. Dysphagia in atlanto-occipital dislocation is induced by medullary compression and lower cranial nerve injury. Therefore, in survivors who are diagnosed with atlanto-occipital dislocation, any neurological symptoms should be carefully evaluated.

Atlantoaxial Instability Resulting in Intractable Nausea in a Person with C5 Complete Spinal Cord Injury: A Case Report

“…Traumatic atlanto‐occipital dissociation is a rare injury, occurring in 1%‐8% of all cervical spine injuries . Furthermore, atlanto‐occipital dislocation is often missed on presentation due to its rarity, with almost 20% of patients with subluxation injury presenting with initial normal neurologic examine . Upon reimaging of this patient, migration of the dens onto the lower brain stem was noted; this compression was focused on the medulla, which comprises the emetogenic center of the brain, ultimately causing this patient's intractable nausea .…”

“…16,17 Furthermore, atlantooccipital dislocation is often missed on presentation due to its rarity, with almost 20% of patients with subluxation injury presenting with initial normal neurologic examine. [18][19][20] Upon reimaging of this patient, migration of the dens onto the lower brain stem was noted; this compression was focused on the medulla, which comprises the emetogenic center of the brain, ultimately causing this patient's intractable nausea. 3 Due to the small number of cases reported with atlantoaxial instability, there is no consensus regarding treatment, which can range from conservative simple distraction therapy to craniocervical fusions and decompressions.…”