Unusual Clinical Course of Odontoid Fracture: Transient Prehospital Cardiopulmonary Arrest

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.