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Atlanto-occipital dislocation

Case contributed by Dr Chad Wong

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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