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Arquivos de Neuro-Psiquiatria

Print version ISSN 0004-282X

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

http://dx.doi.org/10.1590/0004-282X20140163 

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). 

References

. 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 [ Links ]

. 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 [ Links ]

. 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 [ Links ]

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: wladimirbvrpinto@gmail.com

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.