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Basilar Impression - Symptoms, Diagnosis and Treatment

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A basilar impression occurs due to damage to the bones supporting the neck. Read the article to know in detail.

Medically reviewed by

Dr. Varun Chaudhry

Published At December 6, 2022
Reviewed AtFebruary 6, 2023

Introduction:

The brain is a complex organ that controls various processes regulating the body. The brain is divided into the forebrain, midbrain, and hindbrain. The posterior part of the brain has a stalk-like structure that extends downwards called the brain stem. The brainstem plays an important role in connecting the brain and spinal cord. The spinal cord is made of nerve cells and bundles of nerves that carry messages from the brain to other parts of the body. The brain stem consists of the midbrain, pons, and medulla oblongata. In case of any fracture or deformity to the bones supporting the neck, it may result in the compression of the brain stem resulting in a basilar impression.

What Is Basilar Impression?

The neck is supported by a column of bones called the cervical vertebrae. There are seven cervical vertebrae ranging from C1 to C7. These cervical vertebrae are separated from one another by the intervertebral disc. The first and second cervical vertebrae have unique shapes and functions. The first cervical vertebra, C1, is also called the atlas. It is a ring-shaped bone that begins at the base of the skull. It articulates with the occipital bone in the base of the skull to form the atlantooccipital joint. When the top portion of the spine gets pushed into the base of the skull due to conditions like bone fracture, abnormal softening of the neck bones, or flattening of the base of the skull, it causes compression of the brain stem, which carries nerve bundles from the brain. The compression of the spine against the base of the skull is called basilar invagination. The mild form of basilar invagination is called a basilar impression.

What Are the Symptoms of a Basilar Impression?

The signs and symptoms of basilar impression may vary from moderate to severe. Sometimes, these signs may be fatal if there is excess pressure exerted by the basilar impression on the lower brain stem. The symptoms of basilar impression are mentioned below:

  • Headache.

  • Dizziness.

  • Confusion.

  • Difficulty in swallowing.

  • Weakness.

  • Numbness.

  • Nystagmus (rapid eye movement).

  • Neck weakness.

  • Speaking difficulty.

What Are the Conditions Associated With Basilar Impression?

The basilar impression is associated with various conditions, which may be congenital (present at birth) or acquired.

The conditions associated with congenital basilar impression are mentioned below:

Vertebral Defects: Vertebral defects can cause compression of the spinal cord due to deformation of the vertebral column. For example, the fusion of the atlantooccipital joint can cause basilar impressions.

Klippel-Feil Syndrome: Klippel-Feil Syndrome is characterized by the abnormal fusion of two or more bones in the neck. It is a rare bone disorder, and children with this condition have limited head and neck movements and short necks.

Syringomyelia: Syringomyelia is characterized by the presence of a fluid-filled cyst within the spinal cord. A cyst is a collection of fluid. The cyst may enlarge in size over time and damage the spinal cord, causing pain, weakness, and stiffness.

Odontoid Anomalies: Odontoid is a tooth-like projection present in the anterior end of the second cervical vertebrae C2, which is also called the axis. The atlas bone rotates on the odontoid process of the axis. Therefore, any odontoid anomaly can cause limitations to neck movements.

Atlas Hypoplasia: Hypoplasia refers to the lack of cells in an organ or tissue. Atlas hypoplasia usually occurs at birth or when an individual is born with an underdeveloped and incompletely developed atlas.

The conditions associated with acquired basilar impression are listed below:

Paget’s Disease: Paget’s disease is a bone disorder that affects a single bone or several bones, causing constant dull pain. In addition, it causes stiffness and swelling of bones.

Osteomalacia: Osteomalacia is the softening of bones that primarily occurs due to a lack of vitamin D. Vitamin D is important for the absorption of calcium to maintain the strength and rigidity of bones.

Rickets: Rickets occurs in children and cause softening and weakening bones due to prolonged vitamin D deficiency.

Rheumatoid Arthritis: Rheumatoid arthritis is an autoimmune inflammatory disease that mostly affects the joints and causes swelling.

Neurofibromatosis: Neurofibromatosis is a genetic disorder that causes tumors of the nerves.

Ankylosing Spondylitis: Ankylosing spondylitis is an inflammatory disease that causes the fusion of the bones in the spine resulting in less flexibility. It may cause difficulty in breathing if the rib bones are affected.

How Is Basilar Impression Diagnosed?

The diagnosis for basilar impression includes thorough patient history and proper examination of the patient for any signs and symptoms. In addition, a detailed study of the muscles and nerves is done by the physician to check for any numbness or damage. Other methods used to diagnose basilar impressions are magnetic resonance imaging (MRI), x-rays, and computed tomography (CT).

  • X-rays are used to produce images of the internal structures in the body, especially the bones. It is a painless and quick procedure that helps identify bone fractures and abnormal curvature of the bone.

  • MRI scan produces detailed images of the organs and tissues in the body. It is the preferred diagnostic tool to detect abnormalities in the brain and spinal cord.

  • CT scan uses a combination of x-rays and computer technology to produce images of the body. It helps identify muscle and bone disorders.

How Is Basilar Impression Treated?

  • The treatment of basilar impressions primarily focuses on relieving the pain and symptoms associated with the condition. In asymptomatic individuals, a routine follow-up is done every six months to prevent the exaggeration of the condition.

  • In patients with mild symptoms of basilar impression, surgery may not be required. Instead, the symptoms can be treated with non-steroidal anti-inflammatory drugs, which are helpful in pain relief. In addition, the individual may be advised to wear a neck collar. A neck collar is also called a neck brace or cervical collar that acts as a supportive instrument for the neck and spine. It helps to limit neck movements and relieves pain. While wearing a neck collar, strict measures should be followed as advised by the physician. In addition, physiotherapy may also be recommended depending on the severity of the condition and for supportive care.

  • In patients with severe symptoms of basilar impression, surgery is performed to relieve the pressure on the spinal cord or brain stem. The skull and brainstem are stabilized using special spinal instrumentation after removing the pieces of bone that cause compression.

Conclusion:

The basilar impression is the compression of the brain stem due to fracture or bone deformity in the cervical vertebrae that penetrates the base of the skull. The symptoms may be mild, moderate, or severe. Prompt diagnosis, adequate care, and supportive treatment help to relieve the symptoms and lead a quality life.

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Dr. Varun Chaudhry

Radiodiagnosis

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