Retroclival Hematoma

12-year-old male struck by a motor vehicle while riding a bike. On the sagittal STIR-weighted off midline image, there is asymmetric widening of the atlanto-occipital interval with slight anterior translocation of the occipital condyle to the atlas with an associated effusion. The more midline T2 and T1-weighted sagittal and axial images at the level of the craniocervical junction demonstrate avulsion and elevation of the tectorial membrane from the clivus by an underlying hematoma. There is extensive pre vertebral soft tissue edema from the craniocervical junction to the level of the superior endplate of vertebra C4. This is a case of a retroclival hematoma in the setting of a craniocervial dissociation. Craniocervical junction injuries are up to 10x more common in first decade of life as compared to older children and adults. Neurologic status at the time of presentation is the best predictor of outcome.