neurologic disorders
Craniocervical Junction Abnormalities
Symptoms and Signs of Craniocervical Junction Abnormalities
Symptoms and signs of craniocervical junction abnormalities can occur after a minor neck injury or spontaneously and may vary in progression. Presentation varies by degree of compression and by structures affected. The most common manifestations are Evaluation of Neck and Back Pain , often with headache Symptoms and signs of spinal cord compression Neck painoften spreads to the arms and may be accompanied by headache (commonly, occipital headache radiating to the skull vertex); it is attributed to compression of the C2 root and the greater occipital nerve and to local musculoskeletal dysfunction. Neck pain and headache usually worsen with head movement and can be precipitated by coughing or bending forward. If patients with Chiari malformation have hydrocephalus, being upright may aggravate the hydrocephalus and result in headaches. Spinal Cord Compression None Spastic paresis in the arms, legs, or both, caused by compression of motor tracts Commonly, impaired joint position and vibration senses (posterior column function) Tingling down the back, often into the legs, with neck flexion (Lhermitte sign) Uncommonly, impaired pain and temperature senses (spinothalamic tract function) in a stocking-glove pattern Neck appearance, range of motion,or both can be affected by some abnormalities (eg, platybasia, basilar invagination, Klippel-Feil malformation). The neck may be short, webbed (with a skinfold running approximately from the sternocleidomastoid to the shoulder), or in an abnormal position (eg, torticollis in Klippel-Feil malformation). Range of motion may be limited. Brain compression(eg, due to platybasia, basilar invagination, or craniocervical tumors) may cause brain stem, cranial nerve, and cerebellar deficits. Brain stem and cranial nerve deficits include Central Sleep Apnea None Internuclear Ophthalmoplegia (ipsilateral weakness of eye adduction plus contralateral horizontal nystagmus in the abducting eye with lateral gaze) Downbeat nystagmus (fast component downward) Hoarseness Dysarthria Dysphagia Cerebellar Disorders usually impair coordination. Vertebrobasilar ischemiacan be triggered by changing head position. Symptoms may include Intermittent syncope Drop attacks (sudden, unprovoked falls) Vertigo Confusion or altered consciousness Weakness Visual disturbance Syrinx of the Spinal Cord or Brain Stem None Segmental flaccid weakness and atrophy, which first appear or are most severe in the distal upper extremities Loss of pain and temperature senses in a capelike distribution over the neck and proximal upper extremities However, light touch is preserved. 