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 invagination11 . 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.000036577...
must be included in the differential diagnosis of
exercise-induced headache with recurrent torticollis22 . 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-...
, especially if pyramidal signs, ataxia or other
cranio-vertebral anomalies in the neuraxis are present11 . 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.000036577...
,33 . 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...
.
(A-D) Noncontrast cranial CT axial slices showing a higher position of the odontoid (white arrow).
(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
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1Smith 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 -
2Queiroz 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 -
3Goel 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