M Ramanamma is a 48-year-old female who presented with neck pain and paresthesias in her limbs for the past 5 months. On examination, she had decreased strength in her right upper and lower limbs and hypertonia in her lower limbs. Imaging showed atlantoaxial dislocation with compression of the cervical spinal cord at C1-C2, explaining her symptoms.

1. • M Ramanamma,48/F, 1297978
• Diagnosis – Atlanto axial dislocation
• C/o neck pain for 5 months, sharp type, more on
bending forward
• H/o paresthesias in all limbs, more on right side
upper and lower limbs
• H/o pain radiating to both upper and lower limbs,
more in right upper limb.
• H/o slippage of objects from right hand, chappals
from right feet,.
• No h/o trauma, bowel or bladder complains,
weakness of limbs.

2. • GCS- E4V5M6
CNS- Motor system
Tone- UL- Normal
LL- grade 1 hypertonia
Bulk- normal
Power- Right Left
Upper limb
Shoulder- 4+/5 4+/5
Elbow- 4+/5 4+/5
Wrist- 4+/5 4+/5
HG 90% 100%
Lower limb
Hip- 4+/5 4+/5
Knee- 4+/5 4+/5
Ankle- 4+/5 4+/5
EHL- 4+/5 4+/5
• DTR: BJ TJ S KJ AJ
Right - 3+ 3+ 3+ 3+ 3+
Left - 3+ 3+ 3+ 3+ 3+
Plantars- B/L extensors

3. • Sensory system- intact
• No cerebellar signs

5. CSF FLOW STUDY- COMPRESSION AT
CVJ PRESENT

7. MYELOGRAM

9. EXTENSION
RIGHT- LEFT

10. FLEXION
RIGHT- LEFT

11. CLIVAL ANGLE

12. MC RAE LINE

13. CORONAL

14. • Tip of dens 1.5 mm above Chamberlains line
• 1.6 mm above Mc Gregors line

15. Parameters:
• CSF flow – no flow at CVJ
• AAD present
• No BI
• Platybasia
• SI - 900
• Clival canal angle – 1290
• Welchers angle – 1440