Unrecognized traumatic atlanto-occipital dislocation

This report describes the case of a 67-year-old male victim of an auto-pedestrian accident who was alert and neurologically intact on initial presentation. The patient denied head or neck pain and was without evidence of craniocervical injury. A lateral c-spine radiograph did not show any abnormal findings. The patient deteriorated during his trauma evaluation and was refractory to resuscitation. At autopsy, he was found to have an atlanto-occipital dislocation (AOD). The case is discussed and the anatomic, clinical, and radiographic features of atlanto-occipital dislocation are reviewed.