RADIOLOGY IN SURVIVORS OF TRAUMATIC ATLANTOOCCIPITAL DISLOCATION

Traumatic atlanto-occipital dislocation is fatal, but survivals are re ported. Six cases of survival after atlanto-occipital dislocation are presented. Lateral cervical spine radiographs demonstrated retropharyn geal swelling in all patients, and Powers' ratio was abnormal in five of six patients. Reformatted computed tomography (CT) images or three- dimensional CT were useful in confirming the diagnosis. Initial treatm ent consisted of immobilization with halo or collar, and, in one patie nt, Crutchfield tongs. Reduction of the dislocation was associated wit h decreasing Powers' ratio in five long-term survivors. Residual neuro logic deficits, however, were seen in these patients. Atlanto-occipita l dislocation should be suspected in trauma patients with findings of brain stem injury-especially agonal respirations, irregular heart rate , lower cranial nerve abnormality, and asymmetrical motor deficits.