Question

64-year-old woman is brought to the emergency room by ambulance after being the restrained driver in a motor vehicle collision. She fell asleep at the wheel, crossed the highway median, and hit another car head-on at 60 miles per hour. There was a fatality in the other vehicle. On examination, the patient is alert and screaming in pain. Her exam is notable for absent shoulder shrug, 0/5 strength of the upper extremities and 5/5 strength of the lower extremities. Her X-ray reveals anterior displacement of the occiput relative to the atlas. Which of the following is the most likely diagnosis?

A) Atlanto-axial dislocation
B) Atlanto-occipital dissociation
C) Translational fracture-dislocation
D) Traumatic spondylolisthesis

Answer 1

The 64-year-old woman with specific neurological deficits and an X-ray showing anterior displacement of the occiput relative to the atlas most likely has Atlanto-occipital dissociation.A) Atlanto-axial dislocation

Step-by-step explanation:

The most likely diagnosis for a 64-year-old woman who was involved in a motor vehicle collision, showing symptoms of an absent shoulder shrug, 0/5 strength of the upper extremities and 5/5 strength of the lower extremities, with an X-ray revealing anterior displacement of the occiput relative to the atlas, is Atlanto-occipital dissociation. This condition involves a severe dislocation of the atlanto-occipital joint, which is where the occipital bone of the skull articulates with the atlas vertebra (C1) at the base of the skull. The symptoms and radiologic findings are indicative of a high-energy traumatic injury to this joint, resulting in instability and neurological deficits due to the dissociation between the head and the cervical spine.

The most likely diagnosis in this case is Atlanto-occipital dissociation (B). This is a severe injury that occurs when there is disruption of the articulation between the occipital condyles of the skull and the superior articular processes of the atlas (C1 vertebra). It is commonly caused by high-velocity trauma, such as motor vehicle accidents, and can result in life-threatening injuries.