Clinical question: Assess for ligamentous injury. Signs and symptoms: Trauma and fall from third floor. Nonenhanced cervical MRI:Examination demonstrates normal anatomical alignment of vertebral column.There is marrow signal replacement (diminished fatty signal intensity on T1 weighted series however isointense on T2 and T2 STIR) of the clivus adjacent to the spheno-occipital synchondrosis concerning for edema.There is also increased T2 and T2 STIR signal intensity superior to the dens at the level of apical tendon which is concerning for injury. A small localized hypointense T2 and T2 STIR collection posterior to the dens with subtle mass effect on the thecal sac is suspected of a small hematoma. Increased soft tissue with hypointense signal intensity extending along the anterior/inferior aspect of the clivus inferiorly to approximate the C2-C3 disc level suspicious for small hematoma. On sagittal T2/T2 STIR subtle hyperintense signal in the articulating space between occipital condyles and C1 as well as C1-C2 articulation as well is concerning for soft tissue injury and possible cranio-cervical dissociation.No convincing evidence of cord signal abnormality. No evidence of spinal stenosis at any level.Findings and concern on this exam were discussed by phone with the referring clinical physician Platt Andrew #6875 at the time of review.Enhanced neck MRA:Examination demonstrates patent bilateral vertebral arteries through the neck and in the intracranial component. No evidence of change in their caliber or evidence of dissection.Bilateral common carotids, internal carotids and external carotid arteries are patent and unremarkable.
1.Nonenhanced MRI of cervical spine demonstrate findings highly suspected for craniocervical dissociation as detailed above. Please see report above.2.Enhanced neck MRA is unremarkable and without detectable vascular injury.