Ocular Manifestation of a Cervical Spine Injury: An Adult Case of Traumatic Atlantoaxial Rotatory Subluxation Manifesting with Nystagmus

BACKGROUND: Atlantoaxial rotatory subluxation (AARS) is a rare type of traumatic cervical spine injury in adults, commonly manifesting with painful torticollis and suboccipital headache. Early diagnosis is mandatory to avoid catastrophic consequences. We report a rare case of a patient with AARS who presented with nystagmus due to rotational vertebral artery occlusion. CASE DESCRIPTION: A 35-year-old man was evaluated in the emergency department after falling from 9-m height. In the intensive care unit, left-sided torticollis and nystagmus were noted in the patient. Reassessment of the patient with cervical computed tomography scans revealed AARS type 1. After applying cervical traction and confirmation of partial reduction, the nystagmus resolved, and treatment was continued with posterior C1-2 fusion. CONCLUSIONS: Careful neurologic examination is of paramount importance in diagnosis and management of cervical spine injuries. Nystagmus, as a well-known manifestation of rotational vertebral artery syndrome, can be the presenting symptom of AARS.