![]() ![]() The mid-sagittal T2-weighted TSE and enhanced T1-weighted Spin Echo with fat-suppression MR images demonstrate atrophy and myelomalacia of the cord, the presence of the OO, a retrodental soft tissue mass and linear enhancement due to venous stasis. The anterior arch of the atlas is hypertrophic. ![]() There is also a retrodental soft tissue mass indenting the spinal cord. The axial CT scans and mid-sagittal reconstructions reveal that the tip of the odontoid lies well below C1 and that the ossicle is well corticated. It also reveals that Wackenheim's clivus baseline falls tangentially to the anterior aspect of the os instead of the posterior aspect of the tip of the odontoid process. The plain lateral radiograph shows absence of the odontoid process. The imaging findings are typical of os odontoideum (OO). She also mentioned a head trauma 45 years previously that did not require hospitalisation. The patient's medical history included a total right hip arthroplasty and osteoarthritis of the right knee. The complete biochemical workout was unremarkable. The symptoms had appeared 1 year prior to admission and the patient's condition was progressively deteriorating.Ĭlinical examination revealed bilateral pyramidal signs with right predominance, bilateral Babinski signs, right Barré sign and increased reflexes bilaterally with right predominance, without sensory deficiency. She also mentioned urinary dysfunction, namely urgency. The patient was admitted to hospital with gait disturbance, spasticity of the lower extremities, and ataxia. ![]()
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