Authors of section


Ronald Lehman, Daniel Riew, Klaus Schnake

General Editor

Luiz Vialle

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Atlanto occipital dissociation

Atlanto occipital dissociation are typically the result of motor vehicle accidents. They are potentially fatal (mortality rate 50-60%).

Immediate diagnosis and treatment is crucial for a good outcome.

Diagnosis is made using CT imaging, and if there is any doubt about the diagnosis, MRI.

Those who survive an atlanto-occipital dissociation often present unconscious with sign of brain or spinal cord injury.

These injuries are treated with immediate stabilization in a halo device followed by occipitocervical fusion as soon as possible.

Further clincial findings include:

  • Tenderness in the posterior craniocervical transition
  • Dysphagia mainly in delayed presentation (glossopharyngeus, vagal, or hypoglossus nerve palsy)
  • Hoarseness and numbness in the anterior part of the ears as well as the auditory canal (vagal nerve lesion)
  • Torticollis or weakens in lifting the shoulders or abduction of the arm (accessory nerve damage)
  • Deviation of the tongue (lesion of the ipsilateral hypoglossal nerve)
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