# Atlanto-Occipital Dissociation With Catastrophic Neurological Injury: Ethical Challenges in the Intensive Care Setting

## TL;DR

A rare and severe spinal injury called atlanto-occipital dissociation poses ethical challenges in intensive care due to poor patient outcomes and decisions about organ donation.

## Contribution

This paper presents a case highlighting ethical and diagnostic challenges in managing atlanto-occipital dissociation in critical care.

## Key findings

- Atlanto-occipital dissociation is a rare but severe injury with poor prognosis despite advances in prehospital care.
- Early diagnosis and interdisciplinary ethical decision-making are crucial in managing patients with AOD.
- AOD raises complex ethical issues regarding therapeutic futility and organ donation in critical care.

## Abstract

Atlanto-occipital dissociation (AOD) is a rare but severe cervical injury usually caused by high-energy trauma and often fatal before hospital admission. Advances in prehospital care have led to more patients surviving long enough for diagnosis, although their prognosis remains poor. We report a 42-year-old man who fell from approximately 5 meters, resulting in cardiorespiratory arrest at the scene. After achieving return of spontaneous circulation, imaging revealed AOD along with severe traumatic brain injury and widespread brainstem damage. Given the absence of neurological viability and the severity of his injuries, no surgical procedures were performed. The patient was admitted to the intensive care unit as a potential organ donor. This case highlights the diagnostic and ethical challenges caused by AOD in critical care. Early recognition of this severe injury is crucial, but clinicians must also face complex decisions regarding therapeutic futility and organ donation. An interdisciplinary, evidence-based, and ethically grounded approach remains essential in managing such patients. AOD remains a rare but devastating injury with extremely poor outcomes. This case highlights the importance of early suspicion, accurate diagnosis, and ethically guided decision-making in critical care.