Presentation
61 M who presented after a high speed motorcycle collision
Diagnosis
- Type III dens fracture
- Atlantoaxial dissociation with C1-C2 posterior ligamentous disruption
- Ventral epidural hematoma at the site of fracture
Key Findings
Discussion
- Because the type III dens fracture involves right foramen transversarium, this patient would also be a candidate for a CTA neck to evaluate for BCVI
- Widening of C1-C2 interspinous space, subtle bilateral widening of C1-C2 lateral mass articulations, and extensive posterior paraspinous increased STIR signal are all findings that should raise the suspicion for atlantoaxial dissociation with severe posterior ligamentous disruption. Note that some of these findings can also be appreciated on the CT, though the soft tissue injuries make them more obvious on MRI.
- An excellent review on the imaging findings of trauma to the craniocervical junction can be found here: https://pubs.rsna.org/doi/10.1148/rg.2015150035