Basilar invagination in headache associated with physical exertion and recurrent torticollis

Invaginação basilar em cefaleia associada ao esforço físico e torcicolo recorrente

A 52-year-old man presented with a 2-year-history of recurrent torticollis and headache associated with physical exertion (including evacuation). His physical examination disclosed short neck and brachycephaly. Neuroimaging studies (Figures 1 and 2) revealed basilar invagination and brainstem compression without other craniocervical junction abnormalities or systemic diseases. Basilar invagination¹ must be included in the differential diagnosis of exercise-induced headache with recurrent torticollis², especially if pyramidal signs, ataxia or other cranio-vertebral anomalies in the neuraxis are present^1,3.

Figure 1
(A-D) Noncontrast cranial CT axial slices showing a higher position of the odontoid (white arrow).

Figure 2
(A) T1-weighted and (B) T2-weighted midsagittal MR images showing important compression of the brainstem and medulla oblongata and a higher position of the tip of the odontoid process with a greater extension than 5 mm above the Chamberlain line (white asterisk, white line); (C) T2-weighted and (D) T1-weighted axial MR images unvealing ventral compression of medulla oblongata (odontoid process shown by white arrow).

References

• ¹
  Smith JS, Shaffrey CI, Abel MF, Menezes AH. Basilar invagination. Neurosurgery. 2010;66(3 Suppl):39-47. http://dx.doi.org/10.1227/01.NEU.0000365770.10690.6F
  » https://doi.org/10.1227/01.NEU.0000365770.10690.6F
• ²
  Queiroz LP. Symptoms and therapies: exertional and sexual headaches. Curr Pain Headache Rep. 2001;5(3):275-8. http://dx.doi.org/10.1007/s11916-001-0042-x
  » https://doi.org/10.1007/s11916-001-0042-x
• ³
  Goel A. Basilar invagination, Chiari malformation, syringomyelia: a review. Neurol India. 2009;57(3):235-46. http://dx.doi.org/10.4103/0028-3886.53260
  » https://doi.org/10.4103/0028-3886.53260

Publication Dates

• Publication in this collection
  Nov 2014

History

• Received
  27 Feb 2014
• Reviewed
  14 Aug 2014
• Accepted
  02 Sept 2014