What is basilar impression?
Basilar impression is a malformation of the hinge of the cervical skull; this type of malformation may be an isolated case or may be related to multiple systemic syndromes of various organs. Basilar impression is a malformation characterized by a higher position of the epipharyngeal tooth; this causes a decrease in the caliber of the occipital foramen, and may cause compression of the elongated medulla oblongata and cervical cord.
Basilar impression can be of two types:
- Simple basilar impression.
- Basilar impression associated with atlantal-axial dislocation.
Examples of basilar impression are Down syndrome, Klipper Feil syndrome and Chiari syndrome; in all of these there is an upward migration of vertebral elements.
Symptoms of basilar impression
Patients with a basilar impression, in addition to having a short neck, have additional symptoms, such as:
- Neck pain
- Exertional headache
- Mild cranial nerve dysfunction
- Tetraparesis
- Ataxia
- Scoliosis
Exertional headache may be a symptom.
Diagnosis of basilar impression
To diagnose basilar impression, the following tests should be performed:
- Lateral radiography
- Magnetic resonance imaging in the sagittal plane
- CT SCAN
What are the causes of basilar expression?
Basilar impression is a primary, congenital malformation that can be associated with other malformations, such as:
- Chiari malformation
- Syringomyelia
- Syringobulbia
Additional causes may be the presence of bone diseases such as:
- Rheumatoid arthritis
- Hyperparathyroidism
- Paget’s disease
- Osteogenesis
- Rickets
Can it be prevented?
As it is a congenital deformity, it cannot be prevented.
Treatments for basilar impression
For basilar impression, neurosurgery is appropriate when neurological symptoms are present and MRI confirms spinal cord compression. Otherwise, it is advisable to undergo conservative treatment with non-steroidal anti-inflammatory drugs.
Which specialist should be consulted?
In case of basilar impression, a specialist in neurosurgery or neurology should be consulted.