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There is atlanto-occipital dislocation with the cervical spine displaced posteriorly by approximately 13 mm as well as an associated rotatory component. There is gross widening of the basion-dens interval to 19 mm and widening of the basion-axial interval to 25 mm. Faint fracture fragments bilaterally lie within the interval between the dislocated occiput and atlas presumably representing avulsed fracture fragments. There is large volume prevertebral haematoma that extends from the clivus down to the upper thoracic spine. There is resultant high-grade central canal stenosis at the cervico-medullary junction which is severely compressed and kinked by the posteriorly displaced dens. Incidental accessory ossicle of the anterior arch of C1.