Abstract
Odontoid fracture is the most common type of cervical spine fracture in the elderly. Neurological injury due to odontoid fracture is uncommon, but if the injury is severe, it can lead to cardiac arrest. We present a case of odontoid fracture with transient cardiac arrest just after the fall, which fully recovered in a few minutes before arrival at the hospital.A 62-year-old man fell down on a street, and compressions were performed by a witness. On arrival of the emergency medical service, he showed pulseless electrical activity. After two minutes of cardiac resuscitation, he experienced a return of spontaneous circulation and was breathing spontaneously. On arrival at our hospital, his blood pressure was 171/106 mmHg, heart rate was 100 beats per minute, and respiratory rate was 12 times per minute, but he was at Glasgow Coma Scale 3 with an alcohol odor from exhaled breath. Six hours after admission, his level of consciousness improved, and he complained of neck pain and difficulty in movement of his arms and legs. CT revealed a fracture and posteriorly displaced C2 bone. MRI showed a hyper-intense area from C1 to C2. We made a diagnosis of spinal cord injury caused by an odontoid fracture that led to cardiac arrest.An odontoid fracture can cause transient cardiac arrest just after a fall. The possibility of odontoid fracture associated cervical spine injury should be considered in elderly and unconscious patients with minor trauma. Early CT cervical spine in selected patients can be helpful, especially in patients with cardiac arrest, even if it lasted for only a short prehospital period.
Highlights
Odontoid fracture is a common cervical spine fracture of the C2 vertebra in the elderly
computed tomography (CT) cervical spine in selected patients can be helpful, especially in patients with cardiac arrest, even if it lasted for only a short prehospital period
We present a case of odontoid fracture with transient cardiac arrest (CA) just after a fall, with a return of spontaneous circulation (ROSC) in a few minutes before arrival at the hospital
Summary
Odontoid fracture is a common cervical spine fracture of the C2 vertebra in the elderly. Neurological findings indicated a Glasgow Coma Scale (GCS) score of 3 with an alcohol odor from exhaled breath, pupil 4 mm with no difference between left and right, and normal reflection He had a scratch on the front of his head. Electrocardiogram and echocardiography showed no abnormal findings, such as ST elevation or ventricular asynergy, suggesting cardiogenic CA His consciousness had improved to GCS 10 during initial care in the emergency room, so we did not perform targeted temperature management. Sagittal T2-weighted MRI of the neck was performed and showed a hyper-intense area from C1 to C2 (Figure 1C) According to these findings, we made a diagnosis of incomplete spinal cord injury at the C1 to C2 level caused by an odontoid fracture that led to transient CA. He was able to walk with a walker and was discharged for rehabilitation
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