Basilar invagination

Case contributed by Ryan Thibodeau
Diagnosis certain

Presentation

Single generalized tonic-clonic seizure. Evaluate for epileptic focus.

Patient Data

Age: 17 years
Gender: Female

Seizure (epilepsy) protocol

mri
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Axial
T1
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Coronal
T1
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Sagittal
T1
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Axial T2
fat sat
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Coronal
FLAIR
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Coronal
T2
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Axial
DWI
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Axial
ADC
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Axial
FLAIR
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Axial
SWI
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Info

The tip of the dens projects cranially above the foramen magnum. There is posterior displacement of the craniocervical junction. There is associated flattening of the skull base.

Case Discussion

This is an incidental finding of basilar invagination in a patient with Down syndrome (trisomy 21). There is borderline platybasia (angle between the skull base and ~150 degrees).

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