I am a 37 year old female from Kentucky. For the past two years I have been suffering from a constant headache, pain in the back of my neck, tingling in my left arm and leg, dizziness, buzzing tongue, facial pain, visual disturbances, and cognitive problems (short term memory loss, trouble finding words, etc.) Neck movement (siede to side/up and down) causes my my symptoms (esp. headaches) to get worse. Doctors have also noted that my reflexes are extremely brisk, I have “diffuse slowing” on an eeg of the brain and the bloodflow in my carotid arteries is turbulent, “equivalent to 50-70% stenosis” (although there is no plaque.) ?
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One MRI of my cervical spine read as: “There is minimal impression on the anterior aspect of the cervicomedullary junction secondary to the odontoid that is slightly deviated posteriorly. This may be secondary to some minimal atlantoaxial congenital deformity. In addition, there is question of mild thickening of the either posterior periosteum or posterior ligaments.” I’ve included a few pictures from the scans.?
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None of my doctors seem to think this could be causing my symptoms. Because of your highly specialized skill, I was curious to see what you might think. ?
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I understand that it is impossible to give a diagnosis through email. I am just looking for any direction in which I may turn. If you think the odontoid/cervicomedulary junction MIGHT be involved, I feel that would give me the direction I need to pursue here. ?
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I am a wife and mother of three small children. I just want to feel better. Any help would be gratefully appreciated.

Dr. Joshua’s Answer

First I have to stress that I have very limited information and only 1 x-ray, and furthermore I don’t have the benefit of physically examining you so the following is intended solely to give you some ideas to discuss with your own doctors:

Some notes on the X-ray:
The attached cervical spine x-ray shows some spondylosis (bone spurs due to degeneration) but otherwise it seems normal. It’s a small image so detailed inspection is not possible. Also, it’s not possible to evaluate the role of the odontoid process (that’s the part of C2 that is supposedly causing compression of the spinal cord in your case) in any possible compression of the cervicomedullary junction (upper spinal cord) from this X-ray image alone.

I did not receive any other attachments. I would like to see the MRI. I don’t know what’s causing your symptoms, but judging by the MRI report you quoted, it does seems unlikely that your symptoms are caused by this. However, some of your symptoms could theoretically be caused by spinal cord compression, so my advice at this point would be to discuss the following with your doctors:

1. Is there demonstrable significant basilar impression / spinal cord compression? If there is, are these in concordance with symptoms and clinical findings? Has a functional flexion-extension MRI been done, and if not, why not, I think it would be informative in your case. Static MRI will not reveal spinal cord compression if it only occurs when flexing or extending the neck.

2. Is there any evidence of possible c2 nerve root compression possibly causing neck/occipital pain?

3. Is there significant (>50%) carotid stenosis and can it explain some of your symptoms that may be of hemispheric origin (trouble finding words, visual disturbances, tingling/numbness) - if so, should the carotid stenosis be treated surgically (usually >50% stenosis is considered significant)

4. Should a brain MRI be done (if not already)? What is the significance of the EEG finding?

I might recommend that you find a neurologist who would review all the existing data, take a thorough history and perform a neuro exam, and come up with a synthesis and provide you with a strategy for further examinations and/or treatment. It would also help to see a neurosurgeon (and show him/her the MRI and x-rays) about the issue with the odontoid process and possible spinal cord compression.

Keep us posted on the forum, and feel free to ask further questions.

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