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A 19-year-old man was brought to the emergency department after a high-speed motorbike collision. The patient had a score of 3 on the Glasgow Coma Scale (possible scores range from 3 to 15, with higher scores indicating better function), and his blood pressure was 70/35 mm Hg. He did not respond adequately to advanced resuscitation; results of a subsequent emergency laparotomy were normal. After the patient's condition was further stabilized in the intensive care unit, computed tomography of the cervical spine showed major atlanto-occipital dislocation in the lateral view (Panel A) and anteroposterior view (Panel B, arrows), which proved to be fatal.
Early radiography of the cervical spine may help guide resuscitation efforts. Some trauma surgeons favor performing such radiography as part of the secondary evaluation, rather than as part of the primary evaluation. However, in cases such as this one, early radiography can reveal such serious injury that further resuscitative efforts are futile.
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A correction has been published: N Engl J Med 2006;354(9):986.
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