The basilar impression is a pathological abnormality in the area of the cervical vertebrae. The deviation shows up in the transition area of a craniocervical type, whereby an impression develops on the second vertebra of the neck. The dens axis is particularly affected. Because the basilar impression occurs near the foramen magnum, the disease narrows this section.
What is a basilar impression?
Basically, the basilar impression is a disease that occurs in the craniocervical transition area. The floor in the back pit of the skull turns into a funnel shape. The bulge closes around the so-called occipital foramen. In principle, a basilar impression is either congenital or acquired in the course of life.
In the case of genetically determined forms of basilar impression that exist from birth, various syndromes and diseases come into question. For example, the basilar impression occurs more frequently in the context of Arnold-Chiari syndrome and Klippel-Feil syndrome. In addition, the anomaly often forms as part of a dysplasia on the atlas.
The acquired forms of the basilar impression often result from trauma, for example from injuries or accidents, which compress the area in the axial direction. In addition, the basilar impression develops in some cases in the context of osteomalacia, rheumatoid arthritis and weaknesses in the connective tissue.
The disease often occurs together with Ehlers-Danlos syndrome and Marfan syndrome. Finally, the basilar impression develops partly together with a so-called osteodystrophia deformans.
The causes for the typical anomalies of the basilar impression are different. Basically, a distinction must be made between congenital and acquired manifestations of the disease. In the majority of cases it is a congenital developmental disorder. The disease is far less common with osteodystrophia deformans, tumors of the bones or osteomalacia.
In addition, associations of the basilar impression with other malformations can be seen in numerous patients. These anomalies concern, for example, the atlas. The basilar impression also occurs more frequently in connection with Arnold-Chiari syndrome, Klippel-Feil syndrome or syringomyelia.
Symptoms, ailments & signs
The typical symptoms of basilar impression vary depending on the individual case of the disease. In some cases, the disease has an asymptotic course over a long period of time. The first signs of basilar impression are often expressed in pain in the head and neck area.
The pain symptoms, however, tend to be non-specific and only rarely clearly indicate the actual illness. As the disease progresses, the symptoms also increase. In most cases, the affected patients suffer more and more intensely from the symptoms of the basilar impression.
For example, nerves in the brain or in the brain stem are compressed. In addition, the blood supply is impaired by the pathological abnormalities associated with the basilar impression. As a result, various complaints develop in the sick people.
Many patients experience general symptoms such as nausea, vomiting, and attacks of dizziness. Syncope and tachycardia also occur. Some people have paresis or paresthesia, and there may be dysphagia or dysarthria associated with contusion of the cranial nerves.
Diagnosis & course
The basilar impression usually runs smoothly in most of the sick people. In a small group of those affected, the typical symptoms develop from the third or fourth decade of life. A long-lasting headache is usually noticed as one of the first symptoms. In an advanced stage of basilar impression diseased patients dizziness, suffer outbursts of sweat and a tachycardia.
Symptoms of this type of illness are particularly evident when the person concerned turns their head or exerts themselves physically. As soon as the medulla of the cervical spine has been chronically damaged by the disease, the so-called pyramidal tract signs develop on both sides. In connection with this, the affected patients suffer from disorders of sensitivity in the limbs.
Typical cord symptoms arise in the medulla of the back. If the medulla oblongata is further damaged, people suffering from the basilar impression will have symptoms such as cerebellar ataxia, paresis of certain nerves in the brain, and difficulty swallowing. In addition, Horner’s syndrome may develop in such cases.
After taking the patient’s medical history, the doctor conducts clinical diagnostic procedures. He first examines the sick person externally. Signs such as a relatively short neck and various neurological abnormalities already indicate the basilar impression. In the further course of the diagnosis, the attending physician uses various imaging procedures. Are usual x-rays and MRI – and CT scans.
In most cases, this disease involves pain in the neck, head, and neck area. The pain does not have to appear immediately; the course of the disease is often asymptotic, which particularly prevents early diagnosis. Due to the pain in the head area, the person affected is restricted in his actions and in everyday life.
The pain can also lead to depression and other psychological complaints. As a rule, the pain continues to increase as the disease progresses. The brain can also be affected, compressing nerves. This can lead to paralysis or perception disorders.
The extent of these complications depends heavily on the severity of the symptoms. In many cases, however, this leads to vomiting and dizziness. Many patients also suffer from incoordination. The dizzy spells can lead to sweating.
Certain perceptions can be restricted by the emotional disturbances, so that the quality of life of the person concerned decreases extremely strongly. It is usually possible to treat the impression surgically. There are no particular complications and the symptoms disappear completely.
When should you go to the doctor?
If the back pain persists and is associated with unusually intense nausea, a doctor must be consulted immediately, as a basilar impression may be present. The long-lasting headache, which occurs mainly during physical exertion and turning of the head, is also typical of the disease. If this headache occurs in connection with dizziness, sweating and an increased pulse, there may be a basilar impression.
The symptoms described typically show up in the third or fourth decade of life. The basilar impression requires an immediate visit to the doctor, because if left untreated, the symptoms worsen and often lead to depression and other psychological problems. It is therefore advisable to speak to your family doctor as soon as the first symptoms appear. This can rule out or diagnose the basilar impression and then suggest the appropriate treatment. The actual treatment, usually a surgical procedure in which the main brain hole is widened, should then take place as soon as possible.
Since complaints can occur again and again despite successful treatment, the responsible doctor should be consulted at all times. If complications such as bleeding or scarring occur, another visit to the hospital is required.
Treatment & Therapy
The basilar impression can be treated surgically. Neurosurgical procedures are primarily used. The occipital foramen is widened and stabilized as needed. If treatment-related measures are used promptly and successfully, the prognosis of the basilar impression is comparatively good.
Outlook & forecast
The healing prospects of a basilar impression are favorable with early treatment and generally stable health. The prospects are equally good for innate and acquired impressions.
Corrective action is performed in an operation. The surgical procedure is associated with the usual risks and side effects. Depending on the severity of the disease, it represents a challenge for the treating doctor and should only be carried out by an experienced doctor. For some patients, the intensive procedure is difficult to cope with.
In poor health, there is an increased risk of complications. The subsequent healing takes several months. Normally, the patient is then discharged from the treatment as cured. A return of the basilar impression is excluded.
As soon as complications arose, these should be treated in parallel. In addition, the patient should have a check-up at regular intervals. Without medical care, the patient’s state of health cannot be improved. In mild cases of the disease there are no further dangers.
However, in severe cases, blood vessels can be pinched. If the cause is congenital, these patients develop sequelae within the natural growth and development process that lead to a life-threatening condition. If the trapped blood vessels burst, there is a risk of a stroke.
Prevention of basilar impression tends to be difficult due to the large number of potential triggers. According to the current state of research, congenital forms of the disease cannot be effectively prevented in principle.
The extent to which follow-up care is necessary after treated basilar impression depends on the outcome of the operation. Patients cannot prevent illness. Mostly it is a congenital developmental disorder that can be successfully eliminated. The earlier patients start treatment, the better the chances of success. Follow-up care is often not required.
The patient is discharged as cured and can go about his normal professional and private life. If the typical symptoms persist after an operation, a doctor can clearly determine the basilar impression as part of an external inspection. X-rays and computer tomographies also provide clarity.
Physiotherapy is often enough to remedy the symptoms. The number of sessions depends on the individual complaint pattern. Complications are the exception with a basilar impression. They mainly affect the psyche. Depression and constant malaise are permanent as a result of the pain in the head, neck and throat area.
Even dizziness and coordination problems can remain that way. It is not uncommon for lengthy treatment to be necessary in these serious cases. Psychotherapy and administration of medication for pain relief follow. In principle, the length of the follow-up can be shortened by starting therapy early.
You can do that yourself
The basilar impression cannot be cured naturally or through self-help measures. That is why it is urgently advisable to visit your family doctor at an early stage if you experience such complaints. He can quickly clarify the causes of the severely impairing symptoms and, if the diagnosis is positive, quickly initiate the necessary treatment steps.
The sooner a targeted treatment begins, the more reliably it can prevent the disease from progressing. This has a double effect on maintaining quality of life. Firstly, the rapid initiation of appropriate medical measures prevents further development of the painful symptoms and any sensory disturbances that may occur. Second, the risk of psychological complications that can arise from everyday impairments is reduced. The longer the basilar impression remains untreated, the further the health risks increase.
Self-treatment with painkillers without a doctor’s diagnosis should therefore generally be avoided. It cannot eliminate or mitigate the actual causes of the disease. Depending on the severity of the disease, physiotherapeutic measures can be used as part of medical treatment. In this case, the instructions of the physiotherapist should be followed in everyday life. The most important self-help measure with basilar impression, however, is the speedy visit to the doctor.