[blainep]

#27056

Dr. Corenman,

I’d like to get your input on my case: I’ve (25 yo, male) been dealing with odd neurological symptoms since the end of May, including dizziness, orthostatic pressure-like headaches (mainly occipital), heavy headedness, neck and interscapular pain, vertigo, blurred vision, balance problems, pre-syncopal episodes, episodes of severe nausea, heavy limbs, occasional tremulousness, muscle twitches, tinnitus, and low-frequency hearing loss in my left ear. I was very active before the onset of this.

I’ve had an extensive amount of testing (at least 35 different types of blood tests, multiple MRIs, EMG/NCS, skin biopsy, POTS testing, etc). Eventually, it was noticed on my cervical MRI that I had enlarged epidural veins, indicating intracranial hypotension. A blind blood patch provided an almost immediate change in many of my symptoms, but it was short-lived. I eventually began seeing some improvement after a week, but there were some symptoms that didn’t align with intracranial hypotension (such as pressure in the back of my head, as well and my neck and shoulders, that was accompanied by the inability to raise my arms for about ten seconds; muscle twitching; heavy limbs…). I still have issues with balance when upright. It literally feels as if cement is being slowly dumped into the back of my head and neck.

To cut a very long story short: I’ll be seeing an interventional neuroradiologist in several days, but this week I noticed something else on my cervical MRI. I was watching a lecture by the neurosurgeon Fraser Henderson discussing craniocervical instability. One of the main measurements that he uses to determine if somebody has CCI is a clivo-axial angle of <= 135 degrees. I applied it to my cervical MRI and I was surprised to see that is was slightly below 135 degrees. My MRI was taken lying down, and I’m curious to see how much worse it is when upright or in flexion/extension (especially since all of my symptoms are worse when upright). I also noticed that my C2 vertebrae looked odd, as if there was a fracture in the bone. I can only think of one event that would’ve cause something like this seven years ago…

All of my symptoms are also present in individuals with CCI. I think it’s also important to note that when my neck is in flexion (washing dishes, cooking, looking at my phone, reading), my symptoms get worse much faster. In fact, when I felt a sudden increase in pressure in my neck, back, and shoulders – and my arms locked up – I was looking at email on my phone for several minutes. . . Traction also provides relief.

Here are three screenshots from my cervical MRI. Do you think my thoughts are correct?

https://drive.google.com/open?id=1YzGW-F_ktLQjORbtCjwZl5r5c43_tpH4
https://drive.google.com/open?id=19UY2Ic1Bacp05UndEJbhziIDW6RvX3cM
https://drive.google.com/open?id=1hBbMWdShgqtVYOxq4espLYyVWbB_im9B

Thank you!

[Donald Corenman, MD, DC]

#27065

Intracranial hypotension is a rare disorder but I can discuss this disorder. The typical cause is a dural leak. The dura is the membrane that keeps the cerebrospinal fluid (CSF) in the brain and spinal cord cavity. A leak in this membrane (which is rare) can occur with trauma, spinal puncture (from a “spinal” given for numbing the pelvis during birth for example) or even can occur spontaneously due to a congenital defect in this membrane. Sometimes, a degenerative facet at C1-2 or C2-3 can mimic these symptoms but this is also rare.

Cervicocranial instability is even more rare. The strong ligaments of the cervicocranial junction (see https://neckandback.com/conditions/stabilizing-ligaments-upper-cervical-spine-occiput-c2/) only rarely are injured.

The clivoaxial angle is a different problem associated with Chiari malformation. See https://neckandback.com/conditions/chiari-malformation-type-arnold-chiari-syndrome/.

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

[blainep]

#27097

Thanks for the information, Dr. Corenman. I was also interested in getting your opinion on my MRI images in that post. Would that be possible?

[Donald Corenman, MD, DC]

#27123

Sorry but I don’t download images from the Forum. You can have a _long-distance consult” if you so choose for a fee or post the radiological report here and I will comment (for free).

Dr. Corenman

PLEASE REMEMBER, THIS FORUM IS MEANT TO PROVIDE GENERAL INFORMATION ON SPINE ANATOMY, CONDITIONS AND TREATMENTS. TO GET AN ACCURATE DIAGNOSIS, YOU MUST VISIT A QUALIFIED PROFESSIONAL IN PERSON.
 
Donald Corenman, MD, DC is a highly-regarded spine surgeon, considered an expert in the area of neck and back pain. Trained as both a Medical Doctor and Doctor of Chiropractic, Dr. Corenman earned academic appointments as Clinical Assistant Professor and Assistant Professor of Orthopaedic Surgery at the University of Colorado Health Sciences Center, and his research on spine surgery and rehabilitation has resulted in the publication of multiple peer-reviewed articles and two books.

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