Basilar impression primary
Overview
A congenital bone abnormality where the skull and vertebrae meet which can compress some of the brain structures and result in neurological abnormalities. The defect is often associated with other vertebral abnormalities. In severe cases, the cerebrospinal fluid flow may be obstructed which can cause fluid to build up inside the skull (hydrocephalus)
Symptoms
* Short neck * Asymmetrical skull * Asymmetrical face * Pain on moving neck * Torticollis
Diagnosis
Basilar Impression is difficult to assess radiographically, and many measurement schemes have been proposed. CT and MRI scans are very helpful techniques for the evaluation of these patients. CT Scans which incorporate "reconstruction views, in particular, are the most accurate methods and are highly recommended for patients in whom the clinical findings may suggest an Occipitocervical anomaly.
Treatment
Treatment depends on the cause of the symptoms and often requires an extensive Neurosurgical procedure. Occipitocervical Synostosis (with its related anomalies) constitutes a serious risk to severe neurological impairment and death. While most patients are managed, at first, with non-operative measures in the form of traction and support of the neck by a Neck Brace, once neurological signs and symptoms develop consideration should be given to surgical management.