Atlanto-occipital dissociation with malalignment as demonstrated on CT, with widening and asymmetry (joint wider on the left) of the articulations. Complete disruption at the junction of the tectorial membrane and posterior longitudinal ligament at the level of C1/C2, with a 15 mm wide craniocaudal defect in this region. The apical ligament is disrupted. The transverse atlantal ligament posterior to the dens appears intact. Alar ligaments are difficult to identify. Diffuse posterior paraspinous soft tissue oedema throughout the cervical region in keeping with further ligamentous disruption.
High T2/FLAIR signal is present within the cervical cord on the left at the craniocervical junction, extending across midline to the right inferiorly at the level of C1. No increased susceptibility or high T1 signal products demonstrated in this cord region. Small volume adjacent epidural haematoma is not associated with significant compression of the thecal sac. Minor anterior effacement of the right cord just below this level at C1/C2 junction.
Chronic appearing posterior midline cord cleft at the level of C6 correlates with history of previously repaired spina bifida. Mild prominence of the adjacent central canal at the cervicothoracic junction. C6 and C7 laminectomies noted.
High signal on the sagittal STIR sequence at C6/C7 disc level and to a lesser extent at C5/C6 disc level may be degenerative in origin, with differential of undisplaced traumatic involvement. No obvious increased acute fluid is noted within the facet joints to suggest disruption. Sagittal STIR sequences throughout the remaining thoracic, lumbar and sacral spine demonstrate no acute marrow oedema. Dependent layering within the sacral spinal canal is in keeping with intrathecal subarachnoid blood products.
Traumatic lung changes in the visualised upper lung fields, more prominent on the right where there is a posterior pneumothorax and patchy consolidation. Left ICC partially included.