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Traumatic atlanto-occipital dislocation presenting with Dysphagia as the chief complaint: a case report.

Choi EH, Jun AY, Choi EH, Shin KY, Cho AR - Ann Rehabil Med (2013)

Bottom Line: Electromyography confirmed a right spinal accessory nerve lesion.Magnetic resonance imaging confirmed atlanto-occipital dislocation.Therefore, in survivors who are diagnosed with atlanto-occipital dislocation, any neurological symptoms should be carefully evaluated.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.

ABSTRACT
We report a patient with traumatic atlanto-occipital dislocation who presented with dysphagia as the chief complaint. A 59-year-old man complained of swallowing difficulty for 2 months after trauma to the neck. On physical examination, there was atrophy of the right sternocleidomastoid and upper trapezius muscles, and the tongue was deviated to the right. In a videofluoroscopic swallowing study, penetration and aspiration were not seen, food residue remained in the right vallecula and pyriform sinus, and there was decreased motion of the soft palate, pharynx and larynx. Electromyography confirmed a right spinal accessory nerve lesion. Magnetic resonance imaging confirmed atlanto-occipital dislocation. Dysphagia in atlanto-occipital dislocation is induced by medullary compression and lower cranial nerve injury. Therefore, in survivors who are diagnosed with atlanto-occipital dislocation, any neurological symptoms should be carefully evaluated.

No MeSH data available.


Related in: MedlinePlus

The T2-weighted magnetic resonance imaging of the cervical spine in the sagittal section shows medullary compression (asterisk) and disruption of ligaments (arrow).
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Figure 2: The T2-weighted magnetic resonance imaging of the cervical spine in the sagittal section shows medullary compression (asterisk) and disruption of ligaments (arrow).

Mentions: To identify the cause of the dysphagia, brain and cervical magnetic resonance imaging (MRI) were performed. Brain MRI showed no abnormal findings in the brain parenchyma, and therefore, a brain lesion was excluded. Cervical MRI showed medullary compression and disruption of ligaments (Fig. 2). The sagittal section of the cervical computed tomography (CT) clearly showed a posteriorly displaced basion with respect to the tip of the dense of axis, and therefore, a posterior atlanto-occipital dislocation was diagnosed. And in the axial view, bony erosion of the atlas on the right side was shown (Fig. 3). For the treatment of the posterior atlanto-occipital dislocation, surgery was recommended, but the patient refused. Consequently, he underwent occupational therapy for the dysphagia. We educated the patient on a compensatory strategy when swallowing (rotation of the neck to the right side while swallowing food) and advised him to have repeated swallows to reduce pharyngeal residues. And he was also encouraged to perform resistance and range of motion exercises for the oral tongue, tongue base, neck, and shoulders to improve swallowing function. We have followed him for one year, and his dysphagia symptoms (choking during liquid swallowing, sensation of retained residual after swallowing, and food leakage into the nasal cavity) have improved. But, the degree of atlanto-occipital dislocation which was evaluated by X-ray was not changed.


Traumatic atlanto-occipital dislocation presenting with Dysphagia as the chief complaint: a case report.

Choi EH, Jun AY, Choi EH, Shin KY, Cho AR - Ann Rehabil Med (2013)

The T2-weighted magnetic resonance imaging of the cervical spine in the sagittal section shows medullary compression (asterisk) and disruption of ligaments (arrow).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3713304&req=5

Figure 2: The T2-weighted magnetic resonance imaging of the cervical spine in the sagittal section shows medullary compression (asterisk) and disruption of ligaments (arrow).
Mentions: To identify the cause of the dysphagia, brain and cervical magnetic resonance imaging (MRI) were performed. Brain MRI showed no abnormal findings in the brain parenchyma, and therefore, a brain lesion was excluded. Cervical MRI showed medullary compression and disruption of ligaments (Fig. 2). The sagittal section of the cervical computed tomography (CT) clearly showed a posteriorly displaced basion with respect to the tip of the dense of axis, and therefore, a posterior atlanto-occipital dislocation was diagnosed. And in the axial view, bony erosion of the atlas on the right side was shown (Fig. 3). For the treatment of the posterior atlanto-occipital dislocation, surgery was recommended, but the patient refused. Consequently, he underwent occupational therapy for the dysphagia. We educated the patient on a compensatory strategy when swallowing (rotation of the neck to the right side while swallowing food) and advised him to have repeated swallows to reduce pharyngeal residues. And he was also encouraged to perform resistance and range of motion exercises for the oral tongue, tongue base, neck, and shoulders to improve swallowing function. We have followed him for one year, and his dysphagia symptoms (choking during liquid swallowing, sensation of retained residual after swallowing, and food leakage into the nasal cavity) have improved. But, the degree of atlanto-occipital dislocation which was evaluated by X-ray was not changed.

Bottom Line: Electromyography confirmed a right spinal accessory nerve lesion.Magnetic resonance imaging confirmed atlanto-occipital dislocation.Therefore, in survivors who are diagnosed with atlanto-occipital dislocation, any neurological symptoms should be carefully evaluated.

View Article: PubMed Central - PubMed

Affiliation: Department of Physical Medicine and Rehabilitation, Hallym University Chuncheon Sacred Heart Hospital, Hallym University College of Medicine, Chuncheon, Korea.

ABSTRACT
We report a patient with traumatic atlanto-occipital dislocation who presented with dysphagia as the chief complaint. A 59-year-old man complained of swallowing difficulty for 2 months after trauma to the neck. On physical examination, there was atrophy of the right sternocleidomastoid and upper trapezius muscles, and the tongue was deviated to the right. In a videofluoroscopic swallowing study, penetration and aspiration were not seen, food residue remained in the right vallecula and pyriform sinus, and there was decreased motion of the soft palate, pharynx and larynx. Electromyography confirmed a right spinal accessory nerve lesion. Magnetic resonance imaging confirmed atlanto-occipital dislocation. Dysphagia in atlanto-occipital dislocation is induced by medullary compression and lower cranial nerve injury. Therefore, in survivors who are diagnosed with atlanto-occipital dislocation, any neurological symptoms should be carefully evaluated.

No MeSH data available.


Related in: MedlinePlus