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Date : 00.00.00

Name of the Patient : Abc Xyzmar Glmn / M / 17 yrs.
Referred by : Dr. Abc Xyzar.
Examination : M.R.I. of the Cervical Spine.


C/O neck pain on the right side since 1 year with manipulation of the neck 3 months back.
C/O stiffness of neck with inability to eat and speak since then.


M.R.I of the cervical spine was performed using the following parameters :

4 mm thick T1 Weighted and T2 Weighted sagittal images.

5 mm thick T1 Weighted and Fast Scan (T2 *) axial images.

4 mm thick T1 Weighted coronal images.


There is probable occipitalization of the atlas. The C2 and C3 vertebral bodies appear hypointense on the T1 Weighted and hyperintense on the T2 Weighted images. Also seen is involvement of the anterior arch and lateral masses of the atlas. There is an intermediate signal intensity soft tissue lesion on the T1 Weighted images in the prevertebral and anterior epidural region over the C1 to C3 vertebral levels. This lesion also appears hyperintense on the T2 Weighted images. Resultant mild indentation on the anterior dural theca is noted at these levels. Extension of the soft tissue lesion into the neural foramina at the C2-C3 level bilaterally is also noted.

The clivus shows a hyperintense signal on all pulse sequences.

There is evidence of basilar invagination with the tip of the odontoid process compressing the lower medulla and the cervico-medullary junction. The cerebellar tonsils appear beaked. There is also atlanto-dens subluxation with the atlanto-dens interval measuring approximately 7.0 to 8.0 mms.

The rest of the visualized cervical vertebral bodies and the intervertebral discs show normal signal intensity. The joints of Luschka are unremarkable.

The cervical spinal cord reveals normal signal intensity.

Small lymphnodes are noted deep to the sternocleidomastoid muscles bilaterally.


1. Probable occipitalization of the atlas.

2. Altered signal of the C1, C2 and C3 vertebrae
most likely represents osteitis, probably tuberculous osteitis. Prevertebral and anterior epidural extension would represent granulation tissue. (A neoplastic process like a small cell tumor cannot be entirely excluded).

3. Basilar invagination and atlanto-dens subluxation with compression of the lower medulla and cervico-medullary junction. Cerebral tonsillar ectopia is also noted.

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