Atlanto-occipital assimilation with basilar invagination

Case contributed by Utkarsh Kabra
Diagnosis almost certain

Presentation

Neck pain with numbness and tingling in both upper limbs.

Patient Data

Age: 70 years
Gender: Female

Fusion of atlas with occipital bone, superior migration of dens of C2, projecting above foramen of magnum and causing compression and kinking at the cervicomedullary junction.

Intramedullary hyperintensity is seen in cord at C2-3 level.

Degenerative changes are seen with disc-osteophyte complexes at multiple levels causing varying degrees of cord, thecal sac and neural foraminal compression.

Case Discussion

Fusion of atlas with occipital bone, superior migration of dens of C2, projecting above foramen of magnum and causing compression and kinking at the cervicomedullary junction in keeping with complete atlanto-occipital assimilation with basilar invagination.

Intramedullary hyperintensity in the cord at C2-3 level in keeping with compressive myelopathy.

The above findings explain the patient's symptoms of neck pain, tingling and numbness in the upper limbs.

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