88 years Female (DOB:7/22/1927)Reason: fall with c2 fx, ?hematoma History: neck painPROVIDER/ATTENDING NAME: BEN-ZION ROITBERG BEN-ZION ROITBERG Cervical spine:There is traumatic spondylolisthesis of C2 (Hangman's fracture) associated with mild (2mm) anterior subluxation of C2 on C3, 4mm posterior displacement of C2 posterior elements . Fracture lines extend into the vertebral foramina at C2 and a small fracture fragment extends into the left vertebral foramen. There is no evidence for vertebral artery dissection. There is fluid within the C1-2 articulations and adjacent high signal within the lateral masses of C1 and C2.No foci of diffusion restriction are present in the brain.There is fluid ventral to the upper cervical vertebral bodies. There is some The cervical vertebral bodies are appropriate in overall height. At C2-3 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level. There are endplate and uncovertebral osteophytes at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level. There are endplate and uncovertebral osteophytes at this level with mild narrowing of the left neural foramen,At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is mild subluxation and narrowing of the facet joints. There is loss of disk space height at this level. There are endplate and uncovertebral osteophytes at this level with mild narrowing of the left neural foramen,At C7-T1 there is no significant compromise to the spinal canal or neural foramina.Since the prior CT exam circumferential thickening of the epidural space has resolved and was likely related to epidural venous engorgement from collateral venous flow.There is subdural effusion in the posterior fossa likely related to brain atrophy.The right lobe of the thyroid is enlarged and the thyroid id heterogenous.MRA neck:There is a 7x9mm pseudoaneurysm along the left vertebral artery. It originates at the proximal v3 segment at the proximal end of the vertebral foramen and is directed superiorly. There is subtle signal hyperintensity within the left half of the epidural venous plexus at this level. On the contrast enhanced MRV there is contrast present along the adjacent venous structures during the arterial phase of image acquisition. This is less dramatic than on the CTA where the pseudoaneurysm was obscured by the venous engorgement.There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries.
1.There is a 7x9mm pseudoaneurysm along the V3 segment of the left vertebral artery associated with an arteriovenous fistula which is less dramatic than on the CTA. This could represent a traumatic arteriovenous fistula on the CTA which is now regressing but has not resolved. A follow-up MRA using the same exact technique in 24 hours may help monitor its progress,2.Traumatic spondylolisthesis of C2 associated with fracture lines extending into the vertebral artery foramina. There is associated bone edema and ligamentous injury.3.Since the prior CT exam circumferential thickening of the epidural space has resolved and was likely related to epidural venous engorgement from collateral venous flow.4.There is no evidence for acute ischemic cerebral infarction.5.Enlarged right thyroid lobe. Please note that MRI and CT are not accurate in the evaluation of the thyroid.6.Findings were discussed with Dr Roitberg