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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

Arq. Neuro-Psiquiatr. vol.72 no.11 São Paulo Nov. 2014 

Images in Neurology

Basilar invagination in headache associated with physical exertion and recurrent torticollis

Invaginação basilar em cefaleia associada ao esforço físico e torcicolo recorrente

Paulo Victor Sgobbi de Souza1 

Wladimir Bocca Vieira de Rezende Pinto2 

Acary Souza Bulle Oliveira2 

1Universidade Federal de São Paulo, Sao Paulo SP, Brazil

2Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo, Sao Paulo SP, Brazil

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 present1,3.

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). 


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Received: February 27, 2014; Revised: August 14, 2014; Accepted: September 02, 2014

Correspondence: Wladimir Bocca Vieira de Rezende Pinto; Departamento de Neurologia e Neurocirurgia, Universidade Federal de São Paulo; Rua Pedro de Toledo, 650; 04023-900 São Paulo SP, Brasil; E-mail:

Conflict of interest: There is no conflict of interest to declare.

Creative Commons License This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.