Date : 00.00.00
Name of the Patient : Abc Xyzshwar Bolmn / M / 48 yrs.
Referred by : Dr. Abc Xyzdakia.
Examination : M.R.I. of the Cervical Spine.
CLINICAL PROFILE :
Alleged H/O vehicular accident on 00.00.00 followed by weakness of all four extremities 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.
There is forward subluxation of the C4 over the C5 vertebral body. The left lamina of the C4 vertebral body shows a fracture line at the level of the junction of the lamina and the spinous process. Another fracture is also seen involving the right lamina of C5. There is resultant disruption of the C4-C5 facets. An antero-posterior fracture line is seen in the C4 vertebral body (se/im 104.9) with wedging of this vertebra. There is rupture of the anterior and posterior longitudinal ligaments at this level.
The C4 and C5 vertebral bodies show hypointense areas on the T1 Weighted images which are seen to turn heterogeneously hyperintense on the T2 Weighted and Gradient images and would represent edema/bone bruise in the given clinical setting. An intermediate signal intensity lesion on the T1 Weighted images is seen in the posterior aspect of the C4 vertebral body which is seen to compress upon the spinal cord. This is seen to turn heterogeneously hyperintense on the T2 Weighted and Gradient images and may represent a
small hematoma. The spinal cord is swollen and shows a hyperintense signal over the C3 to C6 vertebral level on the T2 Weighted and Gradient images. This is hypointense to the normal cord on the T1 Weighted images and would represent cord edema/contusion.
There is a vertical fracture of the right lateral mass of the C1 vertebral body (se/im 104/3) with clockwise rotation of C1 over C2. An intermediate signal intensity lesion is seen in the prevertebral region extending from the level of the clivus to the C6 vertebral body. This is seen to turn hyperintense on the T2 Weighted and Gradient images and represents edema/contusion/haemorrhagic fluid. Fracture of the posterior arch of C1 is also noted.
Small posterior disc herniations are seen at the C3-C4 and C4-C5 levels and postero-central disc protusions at the C5-C6 and C6-C7 levels.
The cervical intervertebral discs except for the C4-C5 disc show loss of water content.
The rest of the cervical vertebral bodies show normal signal intensity.
In a known C/O trauma the MRI features are suggestive of :
1. Forward subluxation of the C4 over the C5 vertebral body with fracture of the body and laminae of the C4 and resultant disruption of the C4-C5 facets.
- 3 - Scan-00008
2. Swollen spinal cord with altered signal over the C3 to C6 vertebral level would represent cord edema/ contusion.
3. Small epidural hematoma at the C4 vertebral level as described.
4. A vertical fracture of the right lateral mass and posterior arch of C1 with edema/contusion/haemorrhagic fluid in the prevertebral region extending from the level of the clivus to the C6 vertebral body.