Findings
1. Sagittal T2 image shows suspicious fusion anomaly of the upper cervical spine with diffuse syrinx and increased atlantodental interval.
2. On further reading, bilateral atlantooccipital assimilation was observed(2 and 3) with basilar invagination and cerebellar tonsillar herniation(4 and 5). T2 hyperintensity is seen in the visualized cerebellum in image 5. Axial FLAIR(6) shows FLAIR hyperintensity in the left superior hemicerebellum likely acute/subacute infarct(superior cerebellar artery territory). Due to patient discomfort complete MRI Brain could not be performed and patient was immediately referred to Neurology center
Diagnosis
Complex craniovertebral junction anomaly with cerebellar infarction.
Summary
Craniovertebral junction anomalies lead to anomalous course of vertebral arteries that are prone to injury and embolism. Posterior circulation stroke should always be looked for in cases of CVJ anomalies in case of acute events as in this case.
Further reads
1. https://pubs.rsna.org/doi/abs/10.1148/radiographics.14.2.8190952
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