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Cardiopulmonary arrest induced by atlantoaxial dislocation with subarachnoid hemorrhage: a case report and review of the literature.
Spinal Cord Series and Cases ( IF 0.7 ) Pub Date : 2019-12-12 , DOI: 10.1038/s41394-019-0247-z Hiroshi Kageyama 1 , Kousuke Kakumoto 1 , Hiroki Yasuoka 2 , Hirohiko Arimoto 1 , Yukoh Ohara 3
Spinal Cord Series and Cases ( IF 0.7 ) Pub Date : 2019-12-12 , DOI: 10.1038/s41394-019-0247-z Hiroshi Kageyama 1 , Kousuke Kakumoto 1 , Hiroki Yasuoka 2 , Hirohiko Arimoto 1 , Yukoh Ohara 3
Affiliation
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Introduction
Spinal cord injury (SCI) with atlantoaxial dislocation (AAD) is often fatal. We present the case of a resuscitated patient with AAD and traumatic subarachnoid hemorrhage (SAH) at the craniovertebral junction (CVJ).
Case presentation
We present the case of an 84-year-old man who suffered an observed cardiopulmonary arrest. Cardiopulmonary resuscitation was initiated and spontaneous circulation returned. In the emergency room, the patient's Glasgow Coma Scale was 3 (E1V1M1). No spontaneous respiration was noted. Neuroimaging revealed SAH at the CVJ. Contrast-enhanced computed tomography (CT) revealed a vessel running through the left C2/3 intervertebral foramen into the spinal canal. The ventral space of spinal cord revealed contrast enhancement. Angiography revealed extravasation from the spinal branch of the left vertebral artery, without venous filling. It did not appear to be a vascular malformation with an arteriovenous shunt, but rather a traumatic laceration of the artery. Plain CT and CT angiography suggested AAD. Magnetic resonance imaging revealed injury to the medulla oblongata and upper cervical spinal cord, with AAD and retrodental subligamentous hemorrhage. We embolized the branch of the left vertebral artery and performed a C1 laminectomy. The patient moved his extremities postoperatively.
Discussion
This was a case of injury to the medulla oblongata and upper cervical spinal cord due to AAD with SAH. This is the first report of resuscitated case of traumatic AAD with SAH in the CVJ. Traumatic AAD should be included in the differential diagnosis in case of SAH in CVJ, which may be misdiagnosed as intrinsic SAH.
中文翻译：
寰枢椎脱位伴蛛网膜下腔出血所致心肺骤停：病例报告及文献复习。
简介 脊髓损伤 (SCI) 伴寰枢椎脱位 (AAD) 通常是致命的。我们介绍了一名患有 AAD 和颅椎交界处 (CVJ) 外伤性蛛网膜下腔出血 (SAH) 的复苏患者的病例。病例介绍 我们介绍一名 84 岁男子的病例，他观察到心肺骤停。开始心肺复苏并恢复自主循环。在急诊室，患者的格拉斯哥昏迷评分为3级（E1V1M1）。没有注意到自主呼吸。神经影像显示CVJ处有SAH。对比增强计算机断层扫描 (CT) 显示有一根血管穿过左侧 C2/3 椎间孔进入椎管。脊髓腹侧间隙显示对比度增强。血管造影显示左侧椎动脉脊髓分支外渗，无静脉充盈。这似乎不是动静脉分流的血管畸形，而是动脉的创伤性撕裂伤。 CT平扫和CT血管造影提示AAD。磁共振成像显示延髓和上颈脊髓损伤，伴有 AAD 和牙后韧带下出血。我们栓塞了左侧椎动脉的分支并进行了 C1 椎板切除术。术后患者可以活动四肢。讨论 这是一例因 AAD 合并蛛网膜下腔出血导致延髓和上颈脊髓损伤的病例。这是首例创伤性 AAD 伴 CVJ 蛛网膜下腔出血的复苏病例。 CVJ内发生SAH时，鉴别诊断应包括外伤性AAD，可能误诊为内源性SAH。
更新日期：2019-12-12
中文翻译：
寰枢椎脱位伴蛛网膜下腔出血所致心肺骤停：病例报告及文献复习。
简介 脊髓损伤 (SCI) 伴寰枢椎脱位 (AAD) 通常是致命的。我们介绍了一名患有 AAD 和颅椎交界处 (CVJ) 外伤性蛛网膜下腔出血 (SAH) 的复苏患者的病例。病例介绍 我们介绍一名 84 岁男子的病例，他观察到心肺骤停。开始心肺复苏并恢复自主循环。在急诊室，患者的格拉斯哥昏迷评分为3级（E1V1M1）。没有注意到自主呼吸。神经影像显示CVJ处有SAH。对比增强计算机断层扫描 (CT) 显示有一根血管穿过左侧 C2/3 椎间孔进入椎管。脊髓腹侧间隙显示对比度增强。血管造影显示左侧椎动脉脊髓分支外渗，无静脉充盈。这似乎不是动静脉分流的血管畸形，而是动脉的创伤性撕裂伤。 CT平扫和CT血管造影提示AAD。磁共振成像显示延髓和上颈脊髓损伤，伴有 AAD 和牙后韧带下出血。我们栓塞了左侧椎动脉的分支并进行了 C1 椎板切除术。术后患者可以活动四肢。讨论 这是一例因 AAD 合并蛛网膜下腔出血导致延髓和上颈脊髓损伤的病例。这是首例创伤性 AAD 伴 CVJ 蛛网膜下腔出血的复苏病例。 CVJ内发生SAH时，鉴别诊断应包括外伤性AAD，可能误诊为内源性SAH。
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