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Rief, M; Zoidl, P; Zajic, P; Heschl, S; Orlob, S; Silbernagel, G; Metnitz, P; Puchwein, P; Prause, G.
Atlanto-occipital dislocation in a patient presenting with out-of-hospital cardiac arrest: a case report and literature review.
J Med Case Rep. 2019; 13(1):44-44 (- Case Report) [OPEN ACCESS]
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Autor/innen der Med Uni Graz:
Heschl Stefan
Metnitz Philipp
Orlob Simon
Prause Gerhard
Puchwein Paul
Rief Martin
Silbernagel Günther
Zajic Paul
Zoidl Philipp

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Atlanto-occipital dislocation is a rare and severe injury of the upper spine associated with a very poor prognosis. We report the case of a 59-year-old European man who suffered from out-of-hospital cardiac arrest following a motor vehicle accident. Cardiopulmonary resuscitation was initiated immediately by bystanders and continued by emergency medical services. After 30 minutes of cardiopulmonary resuscitation with a total of five shocks following initial ventricular fibrillation, return of spontaneous circulation was achieved. An electrocardiogram recorded after return of spontaneous circulation at the scene showed signs of myocardial ischemia as a possible cause for the cardiac arrest. No visible signs of injury were found. He was transferred to the regional academic trauma center. Following an extended diagnostic and therapeutic workup in the emergency room, including extended focused assessment with sonography for trauma ultrasound, whole-body computed tomography, and magnetic resonance imaging (of his head and neck), a diagnosis of major trauma (atlanto-occipital dislocation, bilateral serial rip fractures and pneumothoraces, several severe intracranial bleedings, and other injuries) was made. An unfavorable outcome was initially expected due to suspected tetraplegia and his inability to breathe following atlanto-occipital dislocation. Contrary to initial prognostication, after 22 days of intensive care treatment and four surgical interventions (halo fixation, tracheostomy, intracranial pressure probe, chest drains) he was awake and oriented, spontaneously breathing, and moving his arms and legs. Six weeks after the event he was able to walk without aid. After 2 months of clinical treatment he was able to manage all the activities of daily life on his own. It remains unclear, whether cardiac arrest due to a cardiac cause resulted in complete atony of the paravertebral muscles and caused this extremely severe lesion (atlanto-occipital dislocation) or whether cardiac arrest was caused by apnea due the paraplegia following the spinal injury of the trauma. A plausible cause for the trauma was myocardial infarction which led to the car accident and the major trauma in relation to the obviously minor trauma mechanism. With this case report we aim to familiarize clinicians with the mechanism of injury that will assist in the diagnosis of atlanto-occipital dislocation. Furthermore, we seek to emphasize that patients presenting with electrocardiographic signs of myocardial ischemia after high-energy trauma should primarily be transported to a trauma facility in a percutaneous coronary intervention-capable center rather than the catheterization laboratory directly.
Find related publications in this database (using NLM MeSH Indexing)
Accidents, Traffic -
Atlanto-Occipital Joint - diagnostic imaging
Atlanto-Occipital Joint - injuries
Cervical Vertebrae - diagnostic imaging
Critical Care -
Humans -
Intracranial Hemorrhage, Traumatic - complications
Intracranial Hemorrhage, Traumatic - diagnostic imaging
Intracranial Hemorrhage, Traumatic - physiopathology
Joint Dislocations - complications
Joint Dislocations - diagnostic imaging
Joint Dislocations - physiopathology
Magnetic Resonance Imaging -
Male -
Middle Aged -
Out-of-Hospital Cardiac Arrest - diagnostic imaging
Out-of-Hospital Cardiac Arrest - physiopathology
Out-of-Hospital Cardiac Arrest - therapy
Recovery of Function - physiology
Resuscitation -
Spinal Injuries - complications
Spinal Injuries - diagnostic imaging
Spinal Injuries - physiopathology
Tomography, X-Ray Computed -
Treatment Outcome -

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