Purpose or Case Report: Birth related brain and spinal cord injury is uncommon. The pediatric cervical spine has ligamentous laxity, poor muscular development and a cartilaginous predominant vertebral column. This in combination with a large head relative to body size predisposes them to craniocervical junction injuries, especially during instrumented delivery using forceps or vacuum extraction. These injuries cause significant parental and physician distress as it can result in permanent neurological deficit or even death in a previously well fetus.

Clinical suspicion for brain or spinal cord injury should be raised when there is diminished spontaneous movement, apnea, no deep tendon reflexes or no response to painful stimuli. There can be co-existing hypoxic ischemic encephalopathy that can mask the clinical signs of cord injury or intracranial hemorrhage and result in diagnostic delay. It can also worsen the neurologic prognosis if not appropriately managed.

Magnetic resonance imaging findings of cranio-cervical junction injuries and associated extra-axial or cerebral parenchymal hemorrhage has been reported. We present a case series of four patients presenting typically with forceps assisted birth related cervical spine trauma and unexpected associated posterior fossa findings.
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