Brainstem
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]
- Craniocervical instability
- Cervical stenosis
- Autonomic control of energy metabolism
References[edit | edit source]
- ↑ 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.
- ↑ 2.0 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.
- ↑ "Have you ruled out Chiari as a cause of your CFS". Phoenix Rising ME / CFS Forums. Retrieved October 26, 2018.
- ↑ 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.
