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Age: 18 months

Sex: Male

Indication: Trauma, no fracture on cervical spine CT

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Case #3


Findings

  • Uplifting of the tectorial membrane from the clivus with intervening linear T1 signal isointensity and T2/STIR signal hyperintensity
  • T2/STIR signal hyperintensity in the anterior atlantooccipital membrane extending posteriorly between the tip of the clivus and the odontoid process with poor visualization of the apical ligament
  • T2/STIR signal hyperintensity in the C1-C2 interspinous ligament and in the overlying paraspinal soft tissues
  • T2/STIR signal hyperintensity in the bilateral atlantooccipital joints
  • T2/STIR signal hyperintensity in the right cerebellar tonsil
  • No abnormal marrow signal or abnormal alignment


Diagnosis

  • Atlantooccipital dissociation

Sample Report

Findings concerning for atlantooccipital dissociation with hemorrhage in the supraodontal space, possible disruption of the apical ligament, injury to the anterior atlantooccipital membrane, fluid in the bilateral atlantooccipital joints concerning for capsular injury, and separation of the tectorial membrane from the clivus.

Interspinous ligament injury at C1-C2 with overlying soft tissue edema.

No abnormal cord signal. T2/STIR signal hyperintensity in the right cerebellar tonsil is concerning for contusion.


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Images

Atlantooccipital dissociation injury with uplifting of the tectorial membrane from the clivus (red arrow), edema/hemorrhage in the supraodontoid space (yellow arrow), and evidence of injury to the C1-C2 interspinous ligament (blue arrow). Coronal view of the major ligaments at the craniocervical junction. Sagittal illustration of the major cervical spine ligaments. Diagram of helpful measurements to know.



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