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Coagulopathy of the Newborn
Joseph Junewick, MD FACR
over 7 years ago
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Craniocervical Junction Injury

Case Detail

Anatomy: Brain-Spine
Junewick
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 7 years ago
Updated: over 6 years ago
Tags: PEDS
Modality/Study Types: MR
Activities:
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History

10 year old involved in motor vehicle accident. Normal CT of the cervical spine but persistent neck pain.


Case Images


Diagnosis

Craniocervical Junction Injury

Findings

MR – Sagittal fat-suppressed T1 and T2 images of the cervical spine show disrupted atlanto-axial ligament, anterior stripping of the atlanto-occipital ligament from the anterior clivus, nonvisualization of the apical ligament, elevation of the tectorial membrane by edema and hemorrhage, and edema in the posterior interspinous space at C1-C2.

Discussion

The craniocervical junction is functionally and developmentally distinct from the rest of the spine. Injuries in this region are difficult to understand in children and adults. Mechanistic models often fail to explain these injuries probably because forces are often multidirectional and may be sequential or simultaneous. Even though anatomic and curvature transitions are known to be zones of vulnerability in the spine, the craniocervical junction demonstrates the most unique morphology and a dramatic transition between the occiput and the atlas. Various developmental features, such as lax ligaments, elastic boney matrix properties, decreased muscle tone, and shallow articulations likely contribute to injury in this region in children. Craniocervical junction injuries may only be manifest on MR, as shown in this case.

Reference

Junewick J, et al. Occult Injury to the Pediatric Craniocervical Junction. Emergency Radiology 2009; 16(6):483-488.



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