title: Traumatic atlanto-occipital dissociation presenting as locked-in syndrome.
abstract: We present an unusual presentation of unstable atlanto-occipital dissociation as locked-in syndrome. Traumatic atlanto-occipital dissociation is a severe injury that accounts for 15-20% of all fatal cervical spinal injuries. A disruption occurs between the tectorial ligaments connecting the occipital condyle to the superior articulating facets of the atlas, resulting in anterior, longitudinal, or posterior translation, and it may be associated with Type III odontoid fractures. Furthermore, the dissociation may be complete (atlanto-occipital dislocation) or incomplete (atlanto-occipital subluxation), with neurologic findings ranging from normal to complete quadriplegia with respiratory compromise.
authors.affiliation: Duke University School of Medicine, Durham, NC, USA.
authors.forename: Rupen
authors.initials: R
authors.lastname: Desai
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Duke University Medical Center Box 3807, Blue Zone Room 4528, Duke South, Durham, NC 27710, USA. Electronic address: mdkinon@gmail.com.
authors.forename: Merritt D
authors.initials: MD
authors.lastname: Kinon
authors.affiliation: Duke University School of Medicine, Durham, NC, USA.
authors.forename: Daniel B
authors.initials: DB
authors.lastname: Loriaux
authors.affiliation: Division of Neurosurgery, Duke University Medical Center, Duke University Medical Center Box 3807, Blue Zone Room 4528, Duke South, Durham, NC 27710, USA.
authors.forename: Carlos A
authors.initials: CA
authors.lastname: Bagley
mesh_terms: D000328:Adult; D001269:Atlanto-Occipital Joint / Q000293:injuries*; D001270:Cervical Atlas / Q000293:injuries; D006801:Humans; D004204:Joint Dislocations / Q000150:complications*; D008297:Male; D011782:Quadriplegia / Q000209:etiology*; D013124:Spinal Injuries / Q000150:complications*
keywords: Atlanto-occipital dissociation; Cervical spine trauma; Locked-in syndrome