A Case of Traumatic Atlantoaxial Rotatory Subluxation Associated with Severe Multiple Injuries in an Adult

We present a rare case of traumatic atlantoaxial rotatory subluxation in an adult. A 63-year-old woman developed hypovolemic shock after sustaining a left hemothorax, fractured ribs, a pelvic fracture and a fracture of the right fibula in a motor vehicle accident. Consciousness disturbance and right hemiparesis were found after recovery from the shock at another hospital and a head computed tomography (CT) disclosed intracranial hemorrhagic lesions. The patient was transferred to our hospital. The patient presented with torticollis and a neurological examination revealed mild consciousness disturbance (Glasgow Coma Scale E3V4M6) and right hemiparesis. A head CT showed the contusion in the left temporal region and intraventricular hemorrhage. Magnetic resonance image (MRI) disclosed diffuse axonal injury at the splenium. Cervical X-ray and CT revealed atlantoaxial rotatory subluxation. Cervical MRI disclosed a spinal cord injury at the C4 level. After cervical traction, the torticollis improved and administration of steroids and hyperbaric oxygenation therapy were effective for the right hemiparesis caused by the spinal cord injury. Diagnosis of injuries in the upper cervical spine is very important but sometimes difficult in patients with multiple traumatic lesions. The possibility of this lesion must be considered when seeing a patient with multiple traumatic lesions, especially when presenting with head trauma and consciousness disturbance.