Craniocervical Dissociation



Craniocervical Dissociation


James C. Darsie



CLINICAL HISTORY

18-year-old male pedestrian struck by a car traveling 55 mph and thrown 100 feet. The patient suffered a pulseless electrical activity arrest in the field and now presents with fixed and dilated pupils and no neurologic responses.






FIGURE 89A






FIGURE 89B






FIGURE 89C






FIGURE 89D







FIGURE 89E


FINDINGS

Figure 89A: Axial bone window CT image at the level of C1 demonstrates an intact C1 ring; however, the dens is not visualized in its normal position behind the anterior C1 arch. Figures 89B and 89C: Sagittal bone window CT images through the cervical spine demonstrate complete craniocervical dissociation, evidenced by marked widening of the dens-basion interval (double arrow), along with widening of the C1-C2 interspinous distance on the midsagittal image (Fig. 89B). A small avulsed bone fragment arising from the inferior aspect of the anterior C1 arch remains in normal position anterior to the dens; however, the remainder of C1 is superiorly distracted. On the parasagittal image (Fig. 89C) there is a large gap between the lateral masses of C1 and C2, while the atlantooccipital joint remains located. Figure 89D: Axial image from a CTA of the neck demonstrates extravasated contrast (curved arrow) adjacent to a small, opacified right vertebral artery (thin arrow). The left vertebral artery is not seen. Note also, the markedly diminished caliber of the internal carotid arteries (arrowheads). Figure 89E: Axial unenhanced head CT image demonstrates diffuse brain edema with complete loss of gray-white matter differentiation.

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Jun 30, 2016 | Posted by in GENERAL RADIOLOGY | Comments Off on Craniocervical Dissociation
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