Traumatic Atlanto-Occipital Dislocation: Two Cases

Abstract

Two females aged 67 and 29 years were admitted with comatose mentality and sustained blunt trauma from a traffic accident and a fall, respectively. Both patients had a cardiac arrest at the accident scene, and return of spontaneous circulation was achieved after cardiopulmonary resuscitation. The injury severity scores were 38 and 75, respectively, without massive bleeding focus. Upon arrival at the hospital, the initial hemodynamics of both the patients were unstable with a pulse rate of 128 and 80 beats/min and a blood pressure of 79/64 and 39/22 mm Hg, respectively. The first patient was subjected to resuscitative endovascular balloon occlusion of the aorta in the emergency room before checking for trauma series; however, her blood pressure was temporarily elevated and then decreased despite administering high-dose vasopressor infusion. The hemodynamics of the second patient was constantly aggravated with high-dose vasopressor infusion. Subsequently, both patients died in 90 and 56 min, respectively, after their arrivals. The cross-table lateral radiograph of the cervical spine of both the patients showed atlanto-occipital dislocation (AOD) (Figs. 1 and 2.).