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Cranial Neuropathies I, V, and VII–XII
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
A skull base lesion involving the jugular foramen and the hypoglossal canal may affect CNs IX, X, XI, and XII (Collet–Sicard syndrome).15 This presents with ipsilateral deficits including weakness of the trapezius and sternocleidomastoid, vocal cord and pharyngeal weakness, hemi-tongue weakness and atrophy, loss of taste in the posterior third of the tongue, and diminished sensation in the palate, pharynx, and larynx. A skull base lesion may also affect CN XII in isolation. Etiologies include infection, trauma/fracture, and malignancies. A lesion at the level of the clivus may involve multiple cranial nerves including CNs VI and XII; this is seen with malignancy such as nasopharyngeal carcinoma. The occipital condyle may be involved in a neoplastic or inflammatory process, which presents with unilateral occipital pain and ipsilateral hypoglossal neuropathy.18
The Anatomy of Joints Related to Function
Published in Verna Wright, Eric L. Radin, Mechanics of Human Joints, 2020
Lateral location of the skull on the upper cervical spine is provided by the alar ligaments (Fig. 25A), which pass from the top of the dens on each side laterally and superiorly to the medial side of the occipital condyles and adjacent margin of the foramen magnum. These ligaments are taut in flexion and would render rotation impossible at atlantoaxial and atlantooccipital joints were it not for the unusual contours of the lateral atlantoaxial joint surfaces. Both atlantal and axial surfaces are convex anteroposteriorly (140), and in the neutral position the point of contact is at the summits of their curvatures (Fig. 25B). As rotation starts, the atlas descends and closes on the axis by as much as 3 mm (135,137,138), and this allows sufficient laxity in the alar ligaments for rotation to occur (approximately 45° between the occiput and axis, of which 80–90% occurs at the atlantoaxial level) (136,137,139,141). The alar ligaments are attached to the posterolateral region of the summit of the dens, so that the ligament that initially becomes tensed is that on the opposite side to which the face is turning (Figs. 25C and D). This results in small amounts of lateral flexion and translation of the occiput upon the atlas (133,136) (and probably also of atlas upon axis, Refs. 135,139), which has the additional advantage of shining the axis of rotation at the atlantooccipital level posteriorly from the dens to coincide with the center of the spinal cord (138).
‘What’s the matter?’
Published in Roger Neighbour, Jamie Hynes, Iona Heath, The Inner Physician, 2018
Roger Neighbour, Jamie Hynes, Iona Heath
Clearly the doctor requires a working diagnosis as a prerequisite for management or treatment. Moreover, that diagnosis needs to be couched in language that fits with how the doctor understands the patient’s problem to have been caused, and with how any proposed intervention is expected to work. For example: Esther, a middle-aged office worker presents with worsening headaches. In her narrative text she tells of being ‘unable to concentrate on my work’, and ‘getting hauled up before my line manager for a reprimand’. The physical text discloses no neurological or other abnormality apart from some soft tissue tenderness around the occipital condyles. An organically minded doctor might diagnose ‘tension headache’ - and if asked to elaborate on this diagnosis might suggest, ‘Muscle tension around the neck and shoulders is transmitted to the scalp fascia, producing pain.’ Diagnosis in such language is the prelude to an organically focused treatment package that might include prescription analgesics, a programme of neck exercises and the general advice to ‘relax more’. A more psychologically orientated doctor might make a diagnosis of ‘stress-related headaches’, explaining how unresolved worries at work are becoming, literally, ‘a headache’. In this ‘organic-lite’ frame of reference, suggested treatment might include over-the-counter analgesics in the short term and, for longer term relief, advice that Esther should discuss her work problems with her manager and renegotiate some of her duties and expectations.
Brain infarction due to vertebral artery dissection caused by a bone protrusion from the condylar fossa in a juvenile case
Published in British Journal of Neurosurgery, 2020
Mutsumi Fujii, Miki Ohgushi, Takaaki Chin
Symptomatic vertebrobasilar insufficiency, occurring as a result of mechanical occlusion or stenosis of the VA during physiological head rotation, is known as RVAS or Bow Hunter’s syndrome.1 We describe a rare case of a juvenile patient, in whom a suboccipital bone spur caused VA dissection between it and the C1. The etiology of RVAS includes osteophytes (seen in most cases), fibrous bands, cervical disc herniation, C1 or C2 instability, chiropractic manipulation, surgical positioning, a multitude of physical activities, and bony prominence.1 Since the bone spur was extending from the suboccipital bone, this ossification is different from ponticulus posticus that is an abnormal small bony bridge arching backward from the superior articular process to the posterior arch of the atlas. Vascular compression in arteries distal to the C1 is a rare condition and only two cases similar to ours have been reported previously. In the case of a 16-year-old boy who experienced an onset during football practice, thrombus formation or artery-to-artery embolism may account for the occurrence of RVAS, which may be secondary to VA dissection. A bone spur arising from his occipital condyle caused a focal VA dissection.2 The other report is that a case of a 12-year-old boy, related to rotational occlusion and dissection of the VA due to a prominent suboccipital bone mass.3 Including our case, all three cases involved juvenile patients, and the cause of RVAS was a bony prominence from the suboccipital bone.
Effects of the craniocervical flexion and isometric neck exercise compared in patients with chronic neck pain: A randomized controlled trial
Published in Physiotherapy Theory and Practice, 2018
Neck pain that persists for three months or longer is defined as chronic neck pain (CNP) (Jensen and Harms-Ringdahl, 2007), and it appears particularly in the neck region between the occipital condyle and C7 (Gummesson et al., 2006). CNP is becoming increasingly prevalent in society, with current predictions estimating that 48%–67% of individuals will suffer neck pain at some stage of life (Cote, Cassidy, and Carroll, 1998; Takasawa et al., 2015). Patients with CNP demonstrate a reduced ability to maintain an upright posture and a subtle forward drift of the head (Hanten et al., 2000; Szeto, Straker, and O’Sullivan, 2005), which may reflect impaired endurance of the muscle required to control the postural position of the spine over the long term (O’Leary, Jull, Kim, and Vicenzino, 2007).
Spontaneous morphological remodelling of the O-C1 joint after posterior fusion for occipitocervical dislocation
Published in International Journal of Neuroscience, 2022
Chizuo Iwai, Kazunari Fushimi, Satoshi Nozawa, Naofumi Mitsuishi, Hiroyasu Ogawa, Masato Maeda, Norishige Kuramitsu, Haruhiko Akiyama
Incongruity of the O-C1 joint due to OCD was observed in the computed tomography (CT) image (Figure 2); occipital condyle-C1 (CCI) (normal: <2 mm), Basion-posterior Axial line Interval: BAI (normal: <12 mm) and basion-dens intervals (BDI): (normal: <12 mm) were 8 mm, 16.1 mm and 16.5 mm, respectively (Figure 2). According to the Traynelis classification [1], her OCD was classified as Type 1, i.e. anterior displacement of the occiput with regard to the atlas.