Althrough traumatic atlanto-occipital dislocation is perceived to be an uncommon injury frequently resulting in death, improvements in emergency management of the patient in the field, rapid transport, and better recognition have resulted in more survivors of atlanto-occipital dislocation in the past 2 decades. Infrequent observation of patients with atlanto-occipital dislocation and missed diagnosis may impair outcomes of patients with this unusual injury. The case of atlanto-occipital dislocation that is presented here is particularly interesting because the patient was missed diagnosis for eight months after the accident. He came to Prasat Neurological Institute by wheel chair with tetraparesis and could not help himself. After
investigation by cervical spine radiograph and MRI of the cervical spine confirming the diagnosis, he was operated on the following day. The plates were fixed in the occipital bone and lateral mass of the cervical spine on both sides, craniectomy of the occipital bone at the foramen magnum and laminectomy C1 for decompression, then auto bone graft was fused at the occiput and C2. After the operation the patient was sent for 3 months physical therapy, he improved well and gained power of the extremities and could walk with a walker.