Ann Rehabil Med.  2013 Jun;37(3):438-442. 10.5535/arm.2013.37.3.438.

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

• Choi EH
• Jun AY
• Choi EH
• Shin KY
• Cho AR

• KMID: 2219544
• DOI: http://doi.org/10.5535/arm.2013.37.3.438

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.

Keyword

Atlanto-occipital joint; Dysphagia; Cranial nerves

MeSH Terms

Accessory Nerve
Atlanto-Occipital Joint
Atrophy
Cranial Nerve Injuries
Cranial Nerves
Deglutition
Deglutition Disorders
Dislocations
Electromyography
Humans
Larynx
Magnetic Resonance Imaging
Muscles
Neck
Palate, Soft
Pharynx
Physical Examination
Pyriform Sinus
Survivors
Tongue

Figure

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  Fig. 1 (A) The anteroposterior projection of the videofluoroscopic image shows much barium residue in the right vallecula after swallowing the solid component. (B) The lateral projection shows much barium residue in the vallecula and pyriform sinus after swallowing the solid component.

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  Fig. 2 The T2-weighted magnetic resonance imaging of the cervical spine in the sagittal section shows medullary compression (asterisk) and disruption of ligaments (arrow).

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  Fig. 3 On computed tomography, (A) the sagittal section shows the posteriorly displaced basion with respect to the tip of the dense of axis (arrow) and (B) the axial section shows bony erosion of the atlas on the right side (arrow).

Reference

1. Ehlinger M, Charles YP, Adam P, Bierry G, Dosch JC, Steib JP, et al. Survivor of a traumatic atlanto-occipital dislocation. Orthop Traumatol Surg Res. 2011; 97:335–340. PMID: 21273154.

2. Diagnosis and management of traumatic atlanto-occipital dislocation injuries. Neurosurgery. 2002; 50(3 Suppl):S105–S113. PMID: 12431294.

3. Traynelis VC, Marano GD, Dunker RO, Kaufman HH. Traumatic atlanto-occipital dislocation: case report. J Neurosurg. 1986; 65:863–870. PMID: 3772485.

4. Olszewski J. Causes, diagnosis and treatment of neurogenic dysphagia as an interdisciplinary clinical problem. Otolaryngol Pol. 2006; 60:491–500. PMID: 17152798.

5. Harris JH Jr, Carson GC, Wagner LK. Radiologic diagnosis of traumatic occipitovertebral dissociation: 1. Normal occipitovertebral relationships on lateral radiographs of supine subjects. AJR Am J Roentgenol. 1994; 162:881–886. PMID: 8141012.

6. Fujimura Y, Nishi Y, Chiba K, Kobayashi K. Prognosis of neurological deficits associated with upper cervical spine injuries. Paraplegia. 1995; 33:195–202. PMID: 7609975.

7. Cognetti DM, Enochs WS, Willcox TO. Retropharyngeal pseudomeningocele presenting as dysphagia after atlantooccipital dislocation. Laryngoscope. 2006; 116:1697–1699. PMID: 16955007.

8. Woodring JH, Selke AC Jr, Duff DE. Traumatic atlantooccipital dislocation with survival. AJR Am J Roentgenol. 1981; 137:21–24. PMID: 6787884.

9. Takayasu M, Hara M, Suzuki Y, Yoshida J. Treatment of traumatic atlanto-occipital dislocation in chronic phase. Neurosurg Rev. 1999; 22:135–137. PMID: 10547015.