Hosting 728 files, 2951 images, and 4 contributors.

Random Case

Ductal ectasia
Heather Borders, MD
over 9 years ago
Enter A Workflow
Standard2   Academic2

Please choose a workflow. A standard workflow allows you to browse the repository with full case detail; the academic workflow allows you to browse the repository with limited case detail revealed. Double click on the images to launch image viewer.

ARSt Case Repository

Craniocervical Junction Injury

Case Detail

Anatomy: Brain-Spine
Joseph Junewick, MD FACR
Diagnostic Category: Trauma
Created: over 9 years ago
Updated: over 9 years ago
Tags: PEDS
Modality/Study Types: MR
Adobe32 PDF Imagej32 ImageJA


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

Case Images


Craniocervical Junction Injury


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.


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.


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

Corporate Office: 616.363.7272, 3264 North Evergreen Drive, Grand Rapids, MI 49525

Spectrum Health Helen Devos Childrens Hospital GE HealthCare