PMC9515408_01
Image inspection. (A) A cervical X-ray shows atlanto-occipital dislocation, (a) space available for the cord is 23.02 mm, (b) atlanto-dental interval is 4.64 mm. (B) A cervical computed tomography scan shows an acute epidural hematoma in front of the medulla oblongata (red arrow). (C) An arterio-venous shunt runs from the dorsal side of the clivus to the sublingual branch (the neuro-meningeal branch of the left ascending pharyngeal artery) to the right cavernous sinus.
fneur-13-965717-g0001.jpg
PMC9515408_01_fneur-13-965717-g0001.jpg
F1
An atlanto-occipital dislocation was diagnosed in the patient (Figure 1A). Head and cervical CT revealed an epidural hematoma of the medulla oblongata and vertical dislocation of the cervical spine (Figure 1B). Transcatheter arterial embolization was performed using a coil to treat an arterio-venous shunt that ran from the dorsal side of the clivus to the sublingual branch, which is the neuro-meningeal branch of the left ascending pharyngeal artery, to the right cavernous sinus (Figure 1C).
Clinical course. (A) The patient's tongue was completely immobile and he was unable to move it from side to side 3 days after the accident. (B) The patient's tongue could be moved but was slightly atrophied. (C) The patient's tongue could move in full range, and the atrophy improved.
fneur-13-965717-g0002.jpg
PMC9515408_01_fneur-13-965717-g0002.jpg
F2
A clinical evaluation, including Eating Assessment Tool-10, Mann Assessment of Swallowing Ability (MASA), and tongue pressure test, was performed (Figures 2A-C).