Brainstem: Difference between revisions

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(→‎Evidence: I cited a primary source article describing the brainstem's control of the ANS. I also internally linked to the ANS MEpedia page.)
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Brainstem Compression often occurs as a result of [[Craniocervical instability|craniocervical instability (CCI)]].<ref name=":0">{{Cite journal|last=Henderson|first=Fraser C.|last2=Henderson|first2=Fraser C.|last3=Wilson|first3=William A.|last4=Mark|first4=Alexander S.|last5=Koby|first5=Myles|date=2017-03-03|title=Utility of the clivo-axial angle in assessing brainstem deformity: pilot study and literature review|url=https://link.springer.com/article/10.1007/s10143-017-0830-3|journal=Neurosurgical Review|language=en|volume=41|issue=1|pages=149–163|doi=10.1007/s10143-017-0830-3|issn=0344-5607|pmc=PMC5748419|pmid=28258417}}</ref><ref name=":1">{{Cite journal|last=Henderson|first=Fraser C.|last2=Wilson|first2=William A.|last3=Mott|first3=Stephen|last4=Mark|first4=Alexander|last5=Schmidt|first5=Kristi|last6=Berry|first6=Joel K.|last7=Vaccaro|first7=Alexander|last8=Benzel|first8=Edward|date=2010-07-16|title=Deformative stress associated with an abnormal clivo-axial angle: A finite element analysis|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2940090/|journal=Surgical Neurology International|volume=1|doi=10.4103/2152-7806.66461|issn=2152-7806|pmc=PMC2940090|pmid=20847911}}</ref>
Brainstem compression often occurs as a result of [[Craniocervical instability|craniocervical instability (CCI)]].<ref name=":0">{{Cite journal|last=Henderson|first=Fraser C.|last2=Henderson|first2=Fraser C.|last3=Wilson|first3=William A.|last4=Mark|first4=Alexander S.|last5=Koby|first5=Myles|date=2017-03-03|title=Utility of the clivo-axial angle in assessing brainstem deformity: pilot study and literature review|url=https://link.springer.com/article/10.1007/s10143-017-0830-3|journal=Neurosurgical Review|language=en|volume=41|issue=1|pages=149–163|doi=10.1007/s10143-017-0830-3|issn=0344-5607|pmc=PMC5748419|pmid=28258417}}</ref><ref name=":1">{{Cite journal|last=Henderson|first=Fraser C.|last2=Wilson|first2=William A.|last3=Mott|first3=Stephen|last4=Mark|first4=Alexander|last5=Schmidt|first5=Kristi|last6=Berry|first6=Joel K.|last7=Vaccaro|first7=Alexander|last8=Benzel|first8=Edward|date=2010-07-16|title=Deformative stress associated with an abnormal clivo-axial angle: A finite element analysis|url=https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2940090/|journal=Surgical Neurology International|volume=1|doi=10.4103/2152-7806.66461|issn=2152-7806|pmc=PMC2940090|pmid=20847911}}</ref>
==Evidence==
==Evidence==
Recent peer-reviewed research indicates that mechanical brainstem compression can be directly responsible for [[dysautonomia]] and fatigue.<ref name=":0" /><ref name=":1" /> When patients had a fusion surgery to correct their brainstem compression, their symptoms of brainstem compression significantly improved or resolved completely.<ref name=":1" />
Recent peer-reviewed research indicates that mechanical brainstem compression can be directly responsible for [[dysautonomia]] and fatigue.<ref name=":0" /><ref name=":1" /> When patients had a fusion surgery to correct their brainstem compression, their symptoms of brainstem compression significantly improved or resolved completely.<ref name=":1" />

Revision as of 23:52, October 26, 2018

Brainstem compression often occurs as a result of craniocervical instability (CCI).[1][2]

Evidence[edit | edit source]

Recent peer-reviewed research indicates that mechanical brainstem compression can be directly responsible for dysautonomia and fatigue.[1][2] When patients had a fusion surgery to correct their brainstem compression, their symptoms of brainstem compression significantly improved or resolved completely.[2]

There are anecdotal accounts of all ME/CFS symptoms, including POTS and fatigue, going away after a craniocervical fusion to correct the brainstem compression.[3]

As the brainstem is central to regulating the autonomic nervous system,[4] it is perhaps unsurprising that dysautonomia (such as POTS) can be alleviated by correcting brainstem compression.

Diagnosis[edit | edit source]

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.[2]

Treatment[edit | edit source]

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,[2] performed by a CCI-literate neurosurgeon.

See also[edit | edit source]

References[edit | edit source]

  1. 1.0 1.1 Henderson, Fraser C.; Henderson, Fraser C.; Wilson, William A.; Mark, Alexander S.; Koby, Myles (March 3, 2017). "Utility of the clivo-axial angle in assessing brainstem deformity: pilot study and literature review". Neurosurgical Review. 41 (1): 149–163. doi:10.1007/s10143-017-0830-3. ISSN 0344-5607. PMC 5748419. PMID 28258417.
  2. 2.0 2.1 2.2 2.3 2.4 Henderson, Fraser C.; Wilson, William A.; Mott, Stephen; Mark, Alexander; Schmidt, Kristi; Berry, Joel K.; Vaccaro, Alexander; Benzel, Edward (July 16, 2010). "Deformative stress associated with an abnormal clivo-axial angle: A finite element analysis". Surgical Neurology International. 1. doi:10.4103/2152-7806.66461. ISSN 2152-7806. PMC 2940090. PMID 20847911.
  3. "Have you ruled out Chiari as a cause of your CFS". Phoenix Rising ME / CFS Forums. Retrieved October 26, 2018.
  4. Martín-Gallego, A.; González-García, L.; Carrasco-Brenes, A.; Segura-Fernández-Nogueras, M.; Delgado-Babiano, A.; Ros-Sanjuán, A.; Romero-Moreno, L.; Domínguez-Páez, M.; Dawid-Milner, M. S. (2017). "Brainstem and Autonomic Nervous System Dysfunction: A Neurosurgical Point of View". Acta Neurochirurgica. Supplement. 124: 221–229. doi:10.1007/978-3-319-39546-3_34. ISSN 0065-1419. PMID 28120078.