title: Ocular Manifestation of a Cervical Spine Injury: An Adult Case of Traumatic Atlantoaxial Rotatory Subluxation Manifesting with Nystagmus.
abstract: BACKGROUND
  Atlantoaxial rotatory subluxation (AARS) is a rare type of traumatic cervical spine injury in adults, commonly manifesting with painful torticollis and suboccipital headache. Early diagnosis is mandatory to avoid catastrophic consequences. We report a rare case of a patient with AARS who presented with nystagmus due to rotational vertebral artery occlusion.
  
  
  METHODS
  A 35-year-old man was evaluated in the emergency department after falling from 9-m height. In the intensive care unit, left-sided torticollis and nystagmus were noted in the patient. Reassessment of the patient with cervical computed tomography scans revealed AARS type 1. After applying cervical traction and confirmation of partial reduction, the nystagmus resolved, and treatment was continued with posterior C1-2 fusion.
  
  
  CONCLUSIONS
  Careful neurologic examination is of paramount importance in diagnosis and management of cervical spine injuries. Nystagmus, as a well-known manifestation of rotational vertebral artery syndrome, can be the presenting symptom of AARS.
authors.affiliation: Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Keyvan
authors.initials: K
authors.lastname: Eghbal
authors.affiliation: Department of Neurosurgery, Shiraz University of Medical Sciences, Shiraz, Iran; Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran. Electronic address: nima_med83@yahoo.com.
authors.forename: Nima
authors.initials: N
authors.lastname: Derakhshan
authors.affiliation: Orthopedic Surgery Department, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Ali
authors.initials: A
authors.lastname: Haghighat
mesh_terms: D000328:Adult; D001268:Atlanto-Axial Joint / Q000000981:diagnostic imaging / Q000293:injuries / Q000601:surgery*; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000293:injuries* / Q000601:surgery; D006801:Humans; D004204:Joint Dislocations / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D009759:Nystagmus, Pathologic / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery*; D012399:Rotation / Q000009:adverse effects; D013119:Spinal Cord Injuries / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods; D014143:Traction / Q000379:methods
keywords: Atlantoaxial rotatory subluxation; Nystagmus; Vertebral artery