The Craniocervical Syndrome and MRI

Meiersa

Description

Rapid advances in MRI are transforming the treatment of patients suffering from the craniocervical syndrome (CCS). Articles in this publication have been written by leading international experts in the field to provide practitioners with a better understanding of the subtle anatomy and MRI appearances at the craniocervical junction, along with insight into the clinical significance of cerebrospinal fluid (CSF) flow measurements and their relationship to posture. The surgical management of patients with damage to the ligaments at the craniocervical junction and the role of cervical spinal trauma in neurodegenerative diseases as well as CSF flow obstruction are also discussed. This publication is valuable reading for practitioners in the fields of radiology, neurosurgery, neurology, pain management, orthopaedic surgery as well as for chiropractors and osteopaths.

Informations

• Publié par: S. Karger AG
• Date de parution: 02 avril 2015
• Nombre de lectures: 0
• EAN13: 9783318026979
• Langue: English
• Poids de l'ouvrage: 5 Mo

Extrait

The Craniocervical Syndrome and MRI

Editors Francis W. Smith Jay S. Dworkin

The Craniocervical Syndrome and MRI

The Craniocervical Syndrome and MRI

Editors Francis W. Smith  Lon don Jay S. Dworkin  Melville, N.Y.

75 figures, 8 in color, 7 tables, and online supplementary material, 2015

BaselFreiburgParisLondonNew YorkChennaiNew Delhi        BangkokBeijingShanghaiTokyoKuala LumpurSingaporeSydney      

Prof. Francis W. Smith Medserena Upright MRI Centre 114a Cromwell Road London SW7 4ES (UK) E-Mail [e-mail]

Library of Congress Cataloging-in-Publication Data

Dr. Jay S. Dworkin FONAR Corporation 110 Marcus Drive Melville, NY 11747 (USA) E-Mail [e-mail]

The craniocervical syndrome and MRI / editors, Francis W. Smith, Jay S. Dworkin.  p. ; cm.  Includes bibliographical references and indexes.  ISBN 978-3-318-02696-2 (hard cover : alk. paper) -- ISBN 978-3-318-02697-9 (electronic version)  I. Smith, F. W. (Francis W.), editor. II. Dworkin, Jay S., editor.  [DNLM: 1. Magnetic Resonance Imaging--methods. 2. Neck Injuries--diagnosis. 3. Brain Injuries--diagnosis. 4. Cerebrospinal Fluid--physiology. 5. Cerebrospinal Fluid Pressure--physiology. 6. Cervical Vertebrae--injuries. 7. Weight-Bearing--physiology. WE 708]  RC386.6.M34  616.07‘548--dc23  2014042567

Disclaimer. The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publisher and the editor(s). The appearance of advertisements in the book is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

Drug Dosage. The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any change in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. © Copyright 2015 by S. Karger AG, P.O. Box, CH–4009 Basel (Switzerland) www.karger.com Printed in Germany on acid-free and non-aging paper (ISO 9706) by Kraft Druck GmbH, Ettlingen ISBN 978–3–318–02696–2 e-ISBN 978–3–318–02697–9

Contents

VII

 1

 9

22

33

48

67

74

92 93

Foreword

Upright Magnetic Resonance Imaging of the Craniocervical Junction Smith, F.W. (London)

The Cranial Cervical Syndrome Defined: New Hope for Postwhiplash Migraine Headache Patients – Cervical Digital Motion XRay, FONAR Upright ® WeightBearing MultiPosition ™ MRI and Minimally Invasive C 1 –C 2 Transarticular Lag Screw Fixation Fusion Franck, J.I.; Perrin, P. (Panama City, Fla.) Online suppl. material, see www.karger.com/doi/10.1159/000365467

Concussion Update: Immunoexcitotoxicity, the Common Etiology of Postconcussion Syndrome, Chronic Traumatic Encephalopathy and Posttraumatic Stress Disorder Maroon, J.C.; Bost, J.; Amos, A.; Winkelmann, R.; Mathyssek, C. (Pittsburgh, Pa.)

Cerebrospinal Fluid Physiology and Its Role in Neurologic Disease Bradley, W.G. (San Diego, Calif.)

The Craniocervical Junction: Observations regarding the Relationship between Misalignment, Obstruction of Cerebrospinal Fluid Flow, Cerebellar Tonsillar Ectopia, and ImageGuided Correction Rosa, S. (Rock Hill, N.Y.); Baird, J.W. (Markham, Ont.)

Positional Venous Magnetic Resonance Angiography Niggemann, P. (Mannheim); Pieper, C.C.; Hadizadeh, D.R. (Bonn)

The Possible Role of Craniocervical Trauma and Abnormal Cerebrospinal Fluid Hydrodynamics in the Genesis of Multiple Sclerosis and the Craniocervical Syndrome Damadian, R.V.; Chu, D. (Melville, N.Y.) Online suppl. material, see www.karger.com/doi/10.1159/000365473

Author Index Subject Index

Foreword

Rapid advances in diagnostic imaging technology have made us all more dependent on MRI images. It is, however, crucial to remember that we treat the patient and not the image. Frequently, the pa- tient will tell us what is wrong if we ask the right questions. This monograph recognizes these ob- servations as particularly germane when examin- ing the implications of abnormalities and injury to the craniocervical junction. There is a broad range of symptoms compris- ing what can rightly be referred to as the cranio- cervical syndrome. It should come as no surprise that the anatomy in the location of the craniocer- vical junction plays a pivotal role. There one will find subtle anatomy with the numerous liga- ments holding everything together all running into each other. The myodural bridge, atlanto- occipital joint, dura mater holding the brain in- side the cranium and the alar ligaments that join the peg to the base of the skull can now be read- ily identified utilizing the correct MRI equip- ment and appropriate pulse sequences. We need to be vigilant and look in more detail at what has been truly damaged in these areas. Subtle details we either oversee or we ignore be- cause we do not fully understand what has hap- pened often go underreported in MRI exams. For instance, if you know what you are looking for, you can appreciate changes in the MRI appear- ance of the smaller ligaments rather than concen- trate on just the larger ligaments, intervertebral discs, fractures and hemorrhage around the lon- gitudinal ligaments. Venous drainage is different in recumbent and upright MRI scans; for in-

stance, when lying down, the jugular vein ap- pears larger because it does not drain as fast as when the patient is upright. Upright MRI also provides the decisive utility of cerebrospinal fluid flow studies around the craniocervical junction that are yielding insight into neurodegenerative diseases such as multiple sclerosis. Increased in- tracranial pressure can also be evaluated using state-of-art MRI techniques; the cerebrospinal fluid accumulation may play a role in traumatic brain injury, stroke and intracranial hemorrhag- es. It also has an impact in normal pressure hy- drocephalus, the symptoms of which may overlap with those of Alzheimer’s disease. Evidence that these problems have become ubiquitous can be found in the reported statistics that there are as many as one million whiplash injuries every year. Reported Chiari I abnormali- ties have increased as sagittal MRI midline slices from routine brain scans now allow for the quan- titation of cerebellar tonsillar ectopia. MRI has impacted the threshold for diagnosis. It is not clear how trauma plays a role in the activation of symptoms attributed to Chiari I type malforma- tion – are symptoms coincidental to trauma, awakened by the trauma or possibly caused by the trauma? This is another avenue of exciting re- search. We welcome you to this fruitful frontier and hope that collecting the insight of this diverse set of researchers will benefit both your practice and patients in the years to come. Francis W. Smith,London Jay S. Dworkin,Melville, N.Y.

Smith FW, Dworkin JS (eds): The Craniocervical Syndrome and MRI. Basel, Karger, 2015, pp 1–8 DOI: 10.1159/000365464

UprightMagneticResonanceImagingof the Craniocervical Junction

FrancisW.Smith Medserena Upright MRI Centre, London, UK

Abstract The importance of scanning the spinal axis in the upright weight-bearing position is described. Recent observations regarding the incidence of cerebellar tonsillar ectopia following whiplash injury of the cra- niocervical junction is discussed, highlighting the in- creased sensitivity when patients are scanned in the upright position. The method of the various measure- ments which should be made in assessing the cranio- cervical junction is described together with an appro- priate illustration. © 2015 S. Karger AG, Basel

Magneticresonanceimaging(MRI)isconven- tionally performed in the supine position, in which no information about the effect of gravity on the patient in the upright position is possible. Humans spend the larger part of each day in the upright position, where most of their musculo- skeletal ailments are experienced. This is especial- ly so along the spinal axis and in the weight-bear- ing joints. With the capability of scanning pa- tients in a standing position, so has come the

ability to use MRI to examine the brain, spine and major joints in the upright position under the ef- fects of gravity. It is not only the alterations in the biomechanics of the body that can be observed, but also alterations in blood flow, venous drain- age and cerebrospinal fluid flow that are now amenable to study under the effects of gravity. This is especially so at the craniocervical junction and in the cervical spine, where the weight of the head on the neck can result in significant altera- tion in the MRI appearance between the supine and upright positions. An adult human head con- stitutes around 8% of the whole body mass and weighs somewhere between 4.5 and 5 kg (9–11 lb) [1]. This weight exerts significant pressure on the craniocervical junction and the cervical spine. The value of being able to image in the upright position is well demonstrated in the case of a 50-year-old woman who had been suffering for many years from neck pain. A prior supine MRI examination had shown a mild degenerative in- tervertebral disc bulge at the C 5 –C 6 level, with a moderate segmental kyphosis (fig. 1). Despite re- peated attempts with conservative treatment, the