PMC9168337_01
(a) CT brain shows intraventricular hemorrhage and hydrocephalus, (b) sagittal MPR shows the intraventricular hemorrhage and extensive extra-axial hematoma anterior to the brainstem and extending to cervical spine, and (c) CT brain (bone window) shows fracture of the right occipital condyle with medial displacement of fractured fragment.
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F1
The initial trauma CT [Figure 1] revealed acute hydrocephalus with subdural, subarachnoid, and fourth ventricular hemorrhage.
CT MPR showing increase in the basion-dens interval from 6 mm to 11 mm between the index CT and the D7 CTA, (b) CT MPR showing increase in the right C0C1 interval from 2 mm to 5 mm between the index CT and the D7 CTA, (c) CT MPR showing increase in the left C0C1 interval from 2 mm to 5 mm between the index CT and the D7 CTA, (d) MR cervical spine (midsagittal T2) shows apical ligament injury and intact tectorial membrane elevated by retroclival hematoma, and (e) MR cervical spine (parasagittal T2) shows C0C1 joint injury with hemorrhage.
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F2
He had CT and MR cerebral angiograms 7 days after presentation to investigate suspected vascular injury and this revealed ligamentous injury at the craniocervical junction [Figure 2].
Intraoperative cervical spine lateral X-rays showing reduction in the basion-dens interval from 13 mm to 6 mm following reduction of the atlanto-occipital dislocation.
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F3
On day 10 postinjury, we proceeded to immobilize the craniocervical junction with a noninvasive pinless halo after reducing the atlanto-occipital dislocation [Figure 3].
Parasagittal MPR views of follow-up CT scans showing well-apposed right C0C1 joint.
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F4
We also performed CT craniocervical junction to monitor the alignment and healing on day 15th day 30th, and day 70th [Figure 4].
CT brain shows worsening in hydrocephalus post-CSF drainage withdrawal.
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F5
He developed worsening hydrocephalus on withdrawal of CSF drainage [Figure 5], and consequently, he underwent insertion of a ventriculoperitoneal shunt 2 months after his injury.
Three-month MR showing healing of craniocervical junction injury and 3-month X-ray showing normal craniocervical junction alignment.
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F6
A follow-up MRI C-spine at 3 months from presentation confirmed resolution of the soft-tissue injury [Figure 6].