Any disorder that affects the adrenal glands.
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pseudomeningocele
An abnormal collection of cerebrospinal fluid (CSF) that forms a pocket inside the cranium, just outside of the dura. Generally occurs as a complication of duraplasty (a common part of a Chiari Decompression surgery). While a small amount of fluid getting through the dura patch is normal after surgery, the body should absorb it and it should resolve within the first month or two. If it fails to reduce in size and resolve, that is a good indication that there is a cranial dura leak exists. A pseudomeningocele are most common amongst patients with an underlying connective tissue disorder (such as Ehlers-Danlos Syndromes) as their dural tissue is more fragile than that of the general population, they are more likely to have problems with the adherence of the patch, and they are more likely to have other comorbid conditions that can further complicate the healing process (such as Intracranial Hypertension, where the untreated high pressure can actually cause a cranial leak). Since the pseudomeningocele is inside the cranium, it can cause a “mass effect” that can raise intracranial pressure.
Symptoms of Atlantoaxial Instability
HEADACHES:
- Suboccipital Headaches
FACIAL PAIN/NERVE DEFICITS:
- Facial Pain
- Occipital Neuralgia (ON)
- Trigeminal neuralgia (TN)
NECK/BACK PROBLEMS:
- Neck pain
- Neck stiffness
- Neck spasms
- Limited neck mobility
- Torticollis (head tilt)
- Odontoid fractures
- Cervical Vertigo
EQUILIBRIUM/BALANCE PROBLEMS:
- Balance impairment
- Unsteady gait
- Incoordination
- Clumsiness
- Dizziness
- Vertigo
CARDIO-RESPIRATORY PROBLEMS:
- Symptoms of Dysautonomia
- Autonomic Hyperreflexia
- Dysphagia (trouble swallowing)
- Hyperactive pharyngeal (gag) reflex
- Drop attacks
- Respiratory distress/failure
COGNITIVE PROBLEMS:
- Fatigability
EYE/VISION PROBLEMS:
- Blurred vision
EAR/HEARING PROBLEMS:
- Tinnitis (ringing in the ears)
- Fullness in the ears
SENSORY PROBLEMS (touch, taste, smell):
- Sensory deficits
PROBLEMS WITH VOICE/SPEECH:
- Hoarseness
- Voice paralysis (full or partial)
PROBLEMS WITH EXTREMITIES:
- Weakness and/or cramping in muscles of arms, shoulders, hands, or legs.
- Tingling and/or numbness of arms, shoulders, or hands
- Loss of sensation in feet
- Burning pain that spreads to the arms, buttocks, or down into the legs (Sciatica)
- Loss of fine motor skills (hand coordination)
- Paraplegia (rare)
- Hemiplegia (rare)
- Quadriplegia (rare)
OTHER PHYSICAL PROBLEMS:
- Bladder and bowel dysfunction
- Other changes
Symptoms of Craniocervical Instability
HEADACHES:
FACIAL PAIN/NERVE DEFICITS:
- Facial pain
- Facial numbness
- Trigeminal Neuralgia (occasionally)
NECK PROBLEMS:
- Heavy head sensation (sensation of the head being too heavy for the neck to hold up)
- Neck pain
- Neck spasms (often severe)
EQUILIBRIUM/BALANCE PROBLEMS:
- Balance impairment
- Unsteady gait
- Incoordination
- Clumsiness
- Dizziness
- Vertigo
CARDIO-RESPIRATORY PROBLEMS:
- Symptoms of Dysautonomia
- Cardiovascular dysfunction
- Neurocardiogenic syncope (fainting)
- Respiratory (breathing) dysfunction
- Central (or mixed) sleep apnea
- Dysphagia (trouble swallowing ; choking)
- Diminished pharyngeal (gag) reflex
EYE/VISION PROBLEMS:
- Double vision
- Downward nystagmus
EAR/HEARING PROBLEMS:
- Tinnitus (ringing in ears)
- Hearing loss
OTHER PHYSICAL PROBLEMS:
- Non epiform seizures
- Paralysis (severe cases)
Symptoms of Intracranial Hypertension
HEADACHES:
- Positional Headache – Pressure headaches that are worse when laying down, and relieved from being upright. Patients often report falling asleep and waking up in the middle of the night with a pressure headache.
- Headache that originates behind the eyes, or (often feeling much like a sinus headache)
NECK PROBLEMS:
- Neck pain/stiffness
- Interscapular (between the shoulder blades) pain/stiffness
EQUILIBRIUM/BALANCE PROBLEMS:
- Dizziness
- Vertigo
COGNITIVE PROBLEMS:
- Mild Aphasia (generally anomic or primary progressive)
- Memory problems (usually short term)
- Brain Fog
EYE/VISION PROBLEMS:
- Nystagmus
- Visual Obscuration in one or both eyes (generally associated with papilledema)
- Blurred vision
- Dimmed vision
- Double vision (diplopia from dysfunction of 6th cranial nerve)
- Poor or decreased peripheral vision
- Flickers/flashes of light (photopsia)
- Moments of occasional blindness
- Permanent blindness
EAR/HEARING PROBLEMS:
- Tinnitus/Pulsatile Tinnitus (ringing in the ears that often pulses in time with your heartbeat), change in hearing
OTHER PHYSICAL PROBLEMS:
- Nausea
- Vomiting
- Hormonal Problems (generally associated with Empty Sella Syndrome and it’s effect on the pituitary gland)
Symptoms of Intracranial Hypotension
HEADACHES:
- Orthostatic Headaches – Pressure headaches that are worse when upright (or after being upright for a period of time), and relieved from laying down. Headaches typically start within 15 minutes of sitting or standing up, and get a measure of relief after lying down for 30 minutes. However, when it comes to cerebrospinal fluid leaks (the most common cause of Intracranial Hypotension), the orthostatic component varies significantly on how long the leak has been present. When a leak first begins, the loss of intracranial pressure has not yet been fully established, and headaches tend to be non-positional. As the leak continues and the intracranial pressure continues to drop, the positional element usually becomes more noticeable. Leaks that have been leaking for a long period of time, tend to have a delayed orthostatic headaches (so the orthostatic feature is easy to miss) or the positional aspect may seem to disappear – headaches take hours to worsen or improve with change of position. They will often wake up in the morning with no headache and get one later in the day when they have spent hours being upright. Likewise, it takes longer to get relief from being supine.
NECK/BACK PROBLEMS:
- Neck pain/stiffness
- Interscapular (between the shoulder blades)
EQUILIBRIUM/BALANCE PROBLEMS:
- Balance impairment
- Unsteady gait
- Incoordination
- Clumsiness
- Dizziness
- Vertigo
COGNITIVE PROBLEMS:
- Memory impairment
- Brain fog
EYE/VISION PROBLEMS:
- Sensitivity to light
- Double vision
- Nystagmus
EAR/HEARING PROBLEMS:
- Tinnitis (ringing in the ears)
- Changes in hearing (muffled sound)
- Sensitivity to sound(s)
SENSORY PROBLEMS (touch, taste, smell):
- Metallic taste (leaks from nose)
PROBLEMS WITH EXTREMITIES:
- Movement disorders, such as chorea or Parkinsonism
- Tremors
- Slow movement
- Stiffness of extremities
Symptoms of Tethered Cord
BACK PAIN:
- Lower back pain, especially when standing, walking or being active
PROBLEMS WITH EXTREMITIES:
- Leg pain
- Numbness in lower legs/feet (tingling/pins-and-needles sensation)
- Gait Disturbance
- History of growing pains
- History of heel or toe walking as a child
- High arches
INCONTINENCE ISSUES:
- Urinary Dysfunction
-
- Urgency
- Frequency
- Incontinence
- Nocturia (waking up to urinate more than 1x per night)
- Trouble emptying bladder
- Hesitancy (trouble starting urinary stream)
- Bowel Dysfunction
-
- Frequent constipation
- Frequent diarrhea
- Occasional bowel incontinence
OTHER PHYSICAL PROBLEMS:
- Frequent UTIs (Urinary Tract Infections) or having the sensation of a UTI
- Decreased sensation in the pelvic area
- Sexual Dysfunction
-
- Decreased sexual interest
- Difficulty reaching orgasm
- Sacral dimple – just above the gluteal cleft (butt-crack)
- Dysautonomia (Dysfunction of The Autonomic Nervous System) when the medulla has been affected
mass effect
The effect of any abnormal, space-occupying mass (such as a cranial cyst, tumor, or hydrocephalus) as it pushes and displaces the surrounding tissue.
Basilar Impression
A congenital or aquired, cranio-cervical junction abnormality where the tip of the 2nd cervical (axis, odontoid process) vertebra is displaced upward and posteriorly (backward) into the intracranial space projecting above the foramen magnum. Basilar Impression is caused by this deformation resulting from softening of the bone (as opposed to Basilar Invagnation wherein the bone is normal). Basilar Invagnation and Basilar Impression both can cause potential compression of the brainstem.
Craniocervical Instability [CCI]
A structural defect and vertical hypermobility (back and forth sliding) of the craniocervical junction (interface between the occipital bone and the 1st and 2nd vertebrae) which can lead to a deformation of the brain stem, upper spinal cord and cerebellum (and associated neurological symptoms) due to compression.
Etiological Co-factors: Heritable Disorders of Connective Tissue (HDCT), such as Ehlers-Danlos Syndrome (EDS).
