Brainstem

Brainstem compression often occurs as a result of craniocervical instability (CCI).

Evidence
Recent peer-reviewed research indicates that mechanical brainstem compression can be directly responsible for dysautonomia and fatigue. Several research studies have shown that when patients had a fusion surgery to correct their brainstem compression, their symptoms of brainstem compression significantly improved or resolved completely.

There are anecdotal accounts of all ME/CFS symptoms, including POTS and fatigue, going away after a craniocervical fusion to correct the brainstem compression.

As the brainstem is central to regulating the autonomic nervous system, it is perhaps unsurprising that dysautonomia (such as POTS) can be alleviated by correcting brainstem compression.

Diagnosis
Brainstem compression is diagnosed via dynamic imaging, such as flexion-extension MRIs and rotational CT scans. The most common measurements used to diagnose and quantify brainstem compression are the Clivo-Axial Angle, the Grabb-Oakes Measurement, and the Basion-Dens Interval.

Treatment
A cervical collar can be tried to see if it helps alleviate the neurological symptoms (even if only partially). However, a cervical collar is not an actual treatment for CCI. The standard treatment to correct brainstem compression is a craniocervical fusion surgery, performed by a CCI-literate neurosurgeon.