High speed motor vehicle collision.
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Alignment of the spine is disrupted.
Widening of bilateral atlanto-occipital joints is present consistent with severe ligamentous spinal injury and atlantooccipital dissociation.
High density material is demonstrated posterior to the dens and would be in keeping with hematoma which extends intracranially.
No cervical spine fracture is identified. ETT and NGT present and therefore prevertebral soft tissues cannot be assessed.
3 case question available
The atlanto-occipital alignment is most easily assessed on coronal and sagittal planes and should be actively assessed on every trauma cervical spine study.