Atlanto-occipital dislocation

Case contributed by Chad Wong
Diagnosis certain

Presentation

Unrestrained passenger in high speed motor vehicle accident with loss of consciousness and PEA arrest at the scene.

Patient Data

Age: 30 years
Gender: Female

Distraction type injury at the craniocervical junction. Fracture-dislocation through the atlas and involving the atlanto-occipital articulations.

Basion-dens interval is 29 mm. The usual interval is <8.5 mm on CT.

Global reduced attenuation with loss of CSF spaces. There is widespread subarachnoid blood, particularly in the posterior fossa suggestive of traumatic subarachnoid hemorrhage.

Annotated image

Basion-dens distance 29 mm (should be <8.5 mm).

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