A Case of Partial Dislocation of the Occipito- 
Atloidean Articulation* 
By J. N. HALL, M.D., and H. L. TAYLOR, M.D., 
Denver, Colorado. A Case of Partial Dislocation of the Occipito- 
Atloidean Articulation. 
The subject of this paper was a well-developed, muscular man, 26 years of 
age, 5 feet 10 inches high, and weighing about 160 lbs. While drinking in a 
saloon he was struck twice in the face lightly, clinched with his opponent, and 
fell backwards, striking his head upon the rail at the base of the bar at which 
he was drinking. He lost consciousness, and was dead before the arrival of a 
physician. 
At the autopsy, sixteen hours after death, a slight bruise was found upon 
the left side of the lower lip, and another on the left tibia. With these excep- 
tions, the examination was entirely negative, aside from the points to be now 
mentioned. 
The calvarium was of rather greater thickness than normal, otherwise 
negative. Underneath the pia was found much clotted blood, particularly in 
the region of the medulla. Upon section, the brain was normal. 
The skull was normal in its relations with the atlas, but was very movable 
upon that bone. The movement of the atlas, by the finger inserted into the 
foramen magnum, could be easily felt by the fingers applied posteriorly to the 
neck. There was no fracture. A ragged tear three-fourths of an inch long 
existed in the tissues binding the occipital bone to the atlas, and the right 
vertebral artery was entirely torn across, just below its entrance to the cavity 
of the skull. This was obviously the source of the hemorrhage within the 
cranium. 
The force of the blows the face seemed to us, from the trivial signs 
remaining, entirely inadequate to the production of such a subluxation. It 
seems more probable, in our opinion, that the subject, easily losing his balance 
from a moderate blow, in falling struck his neck upon the rail mentioned in 
such a way as to cause this rail to act as a fulcrum between the head and the 
body. It is easily conceivable that such a condition as we have described 
might originate in this manner, especially at a time when the muscles were 
more or less relaxed under the influence of alcohol. 
We place this case on record on account of its extreme rarity. Hamilton 
states (Fractures and Dislocations), that “ Lassus, Palatta and Bouisson have 
each reported one example of dislocation of the head upon the atlas. In 
neither case was the dislocation complete, but death occurred speedily in every 
instance.” 
Dariste exhibited to the Anatomical Society of Paris a specimen of this 
incomplete luxation of the occipito-atloidean articulation, with stretching of 
the transverse ligament, the patient from whom the specimen had been taken 
having lived for more than a year after the accident, when he died from a 
tuberculosis of the brain. 
Moullin states that this accident is very rare, but can be produced by a 
violent blow upon the occiput, while the patient is stooping forward. Wyeth 
states that the accident is probably always fatal. Several other authors 
consulted state either that the accident is verv rare, or else do not mention it.