Fig. 22

Multi-focal craniocervical junction osseo-ligamentous traumatic injury in a 51-year-old male driver of a vehicle which collided with a wall at high speed: a: axial CT image through the atlanto-occipital level demonstrates type —III left occipital condyle fracture (black arrow) and type I right occipital condyle fracture (white arrow); b: sagittal T2-weighted image through the craniocervical junction of the same patient—there is oedematous strain injury affecting the apical ligament (bold white arrow) with haemorrhagic fullness of the surrounding supra-odontoid space (apical cave; not annotated). There is strain injury of the transverse ligament with peri-ligamentous fluid surrounding the ligament (black arrow) as well as widening of the anterior atlanto-dental space (not annotated). There is partial tear of the basion attachment of the anterior atlanto-occipital membrane (thin white arrow) and traumatic disruption of the anterior atlanto-axial membrane (severed white arrow). Sizeable prevertebral haematoma and traumatic posterior paraspinal soft tissue oedema are also present (black asterisks); c: coronal image of T2-SPACE sequence through the craniocervical junction of the same patient demonstrates traumatic signal abnormality and partial tear of the left alar ligament (long white arrow) compared with the greater integrity of the right alar ligament (long black arrow), abnormal signal related to disruption of the left transverse ligament (short thin white arrow) compared to the integrity of the right side of the ligament (short thin black arrow). Traumatic effusions are evident affecting both the atlanto-axial joint capsules (Arnold’s ligaments) and the atlanto-occipital joint capsules bilaterally (severed white arrows). Bilateral traumatic otomastoid effusions are present (not annotated) related to lateral skull base fractures (not depicted)