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Cervicocranial syndrome or (craniocervical junction syndrome, CCJ syndrome) is a combination of symptoms that are caused by an abnormality in the cervical vertebrae leading to improper function of cervical spinal nerves. Cervicocranial syndrome is either congenital [1] or acquired. [2]
Underlying problems (e.g. craniocervical junction abnormalities, postoperative scarring, spinal tumors) are corrected when possible. Surgical decompression of the foramen magnum and upper cervical cord is the only useful treatment, but surgery usually cannot reverse severe neurologic deterioration. [citation needed]
Craniocervical instability is more common in people with a connective tissue disease, including Ehlers-Danlos syndromes, [1] osteogenesis imperfecta, and rheumatoid arthritis. [2] It is frequently co-morbid with atlanto-axial joint instability, Chiari malformation , [ 3 ] or tethered spinal cord syndrome .
Several indirect measurements on CT can be used to assess ligamentous integrity at the craniocervical junction. The Wackenheim line, a straight line extending along the posterior margin of the clivus through the dens, should not intersect the dens on plain film, with violation of this relationship raising concern for basilar invagination.
Craniocervical junction misalignment is also suspected as a factor in neurodegenerative diseases where altered CSF flow plays a part in the pathological process. Hyperextension (Whiplash) Injury A rear-end traffic collision or a poorly performed rugby tackle can both result in the head being whipped back on the shoulders, causing whiplash.
The clinicians at Long Island Veterinary Specialists have made advances in the diagnosis and medical management of pets with CM as well as other abnormalities of the craniocervical junction. Some of these advances are made possible using MR imaging to evaluate and the development of a thermal camera-based screening test. [3]
A study using upright MRI found cerebellar tonsillar ectopia in 23% of adults with headache from motor-vehicle-accident head trauma. Upright MRI was more than twice as sensitive as standard MRI, likely because gravity affects cerebellar position. [22] Cases of congenital Chiari malformation may be explained by evolutionary and genetic factors.
The key to Phase-contrast MRI (PC-MRI) is the use of a bipolar gradient. [4] A bipolar gradient has equal positive and negative magnitudes that are applied for the same time duration. The bipolar gradient in PC-MRI is put in a sequence after RF excitation but before data collection during the echo time of the generic MRI modality.