Wk 5, Case 41 - Review

Report


EXAMINATION: MRI brain without contrast. MRI cervical spine without contrast.

CLINICAL HISTORY: 25-year-old male pedestrian struck by vehicle on the left side.

TECHNIQUE: Multiplanar multisequence MRI images of the cervical spine performed without administration of intravenous contrast.


MRI CERVICAL SPINE:
Motion degraded examination.

Redemonstration of an extra-axial hematoma dorsal to the clivus extending to the craniocervical junction measuring up to 5 mm in depth without significant mass effect. T2 hyperintensity and disruption of the right side of the tectorial membrane at this level. The superior crus of the cruciate ligament and/or right alar ligament is likely also injured. Transverse ligament appears intact with a tiny amount of blood beneath it.

Ligamentous injury of the apical ligament with fluid signal in the basion dens interval. Basion dens distance is within normal limits. Craniocervical alignment is preserved.

Mildly displaced fracture of the lower aspect of the anterior arch of C1 with moderate surrounding prevertebral edema.

Trace fluid under the posterior longitudinal ligament dorsal to the odontoid process.

No additional areas of ligamentous injury within the cervical spine.

Normal cord signal in the cervical spine. Minimal disc bulges at C3-4 and C4-5 without significant spinal canal stenosis.


IMPRESSION:
1. Ligamentous injury at the craniocervical junction with disruption of the tectorial membrane, apical segment of the cruciate ligament, and apical ligament to the right of midline. Craniocervical alignment is preserved.
3. Acute fracture of the anterior arch of C1 with moderate surrounding prevertebral edema.
4. Unchanged 5 mm extra-axial hematoma dorsal to the clivus. No mass effect.