Case 23 - Occipital Condyle Fracture

Dr. Yousem has provided the following report as a sample report for your reference. It does not match the case reviewed in the video.

EXAMINATION: MRI brain without contrast. MRI cervical spine without contrast.

CLINICAL HISTORY: 25-year-old male pedestrian struck by vehicle on the left side.

TECHNIQUE: Multiplanar multisequence MRI images of the brain performed without administration of intravenous contrast.

COMPARISON: CT head and cervical spine performed earlier the same day.

FINDINGS:

MRI BRAIN WITHOUT CONTRAST:

Redemonstration of a 8mm hemorrhagic cortical contusion in the lateral left temporal lobe. Additional punctate microhemorrhages within the left parietal operculum (series 11 slice 49) and right frontal lobe subcortical white matter (series 11 slice 63, 51).

No midline shift. No acute infarct.

Ventricles are normal in caliber. Basal cisterns are patent. Major intracranial flow voids are preserved..

Redemonstration of polypoid opacification of the left maxillary sinus extending into the nasal cavity with marked proteinaceous material demonstrating restricted diffusion. Additional mucosal thickening of the left frontal sinus and ethmoid air cells.

Mastoid air cells and middle ear cavities are clear. Orbits are unremarkable.

MRI CERVICAL SPINE:

Motion degraded examination.

Redemonstration of a extra-axial hematoma dorsal to the clivus extending to the craniocervical junction measuring up to 5 mm in depth without significant mass effect. T2 hyperintensity and disruption of the right side of the tectorial membrane at this level. The superior crus of the cruciate ligament and/or right alar ligament is likely also injured. Transverse ligament appears intact with a tiny amount of blood beneath it.

Ligamentous injury of the apical ligament with fluid signal in the basion dens interval. Basion dens distance is within normal limits. Craniocervical alignment is preserved.

Redemonstration of mildly displaced fracture of the lower aspect of the anterior arch of C1 with moderate surrounding prevertebral edema.

Trace fluid under the posterior longitudinal ligament dorsal to the odontoid process.

No additional areas of ligamentous injury within the cervical spine.

Normal cord signal in the cervical spine. Minimal disc bulges at C3-4 and C4-5 without significant spinal canal stenosis.

IMPRESSION:

1. Unchanged 8mm hemorrhagic cortical contusion in the left lateral temporal lobe. Additional punctate microhemorrhages in the right frontal lobe subcortical white matter and left parietal operculum.

2. Ligamentous injury at the craniocervical junction with disruption of the tectorial membrane, apical segment of the cruciate ligament, and apical ligament to the right of midline. Craniocervical alignment is preserved.

3. Redemonstration of acute fracture of the anterior arch of C1 with moderate surrounding prevertebral edema.

4. Unchanged 5 mm extra-axial hematoma dorsal to the clivus. No mass effect.