ChiroACCESS Article



Diagnostic Imaging Case Report: A 14-year-old male reports with chronic headaches



This information is provided to you for use in conjunction with your clinical judgment and the specific needs of the patient.

Jack Henry, DC, DACBR

  

Radiology Diagnostics, LLC



Published on

February 9, 2010

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Hello.  My name is Jack Henry, DC, DACBR.  I am Radiologist-in-Chief of Radiology Diagnostics, LLC, an industry leader of Chiropractic Radiology Services and Digitized Spinographic analyses.  All of our services are provided at no cost to doctor and  no/low cost to patients.

Selected cases will be presented for your evaluation.  The studies may or may not have abnormalities.  Use the arrow keys or the scroll bar to carefully evaluate the films.

Step 1:  Is the study abnormal or normal?

Step 2:  If the study is abnormal, what is your best diagnosis?

Step 3:  Which follow-up imaging option would be best?

Step 4:  Compare your results with the correct diagnosis. 


HISTORY


A 14-year-old male reports with chronic headaches, particularly at night.  No history of recent or past significant trauma was reported.  Neurological and orthopedic exams were essentially unremarkable.





FINDINGS

The study is negative for acute fracture or dislocation.  The C-spine lordosis is flat.  However, this can be a normal finding in this age group.  On close inspection, please note the incomplete segmentation of C2/C3.  The disc at that level is rudimentary.  Of greater significance is suspected basilar invagination utilizing Macgregor’s Line.  No other significant bone or soft tissue abnormality is apparent.


DISCUSSION

Kids should not get headaches!  This should be a red flag!  It is crucial for the attending to characterize the type of headache presenting.  In this case, the headaches were primarily occipital in location and relatively low grade.  This, in combination with the possibility of basilar invagination, is suggestive of possible cerebral fluid flow abnormality that can be associated with basilar invagination.


FOLLOW UP PROTOCOL

Because of the basilar invagination, mechanical obstruction can occur.  This is a relatively common abnormality that is often missed or mis-diagnosed by chiropractors.  Anecdotal evidence suggests chiropractic care can be helpful for patients with this condition.  If symptoms do not abate or worsen after a short clinical trial, advanced imaging (MRI) would be warranted to exclude other conditions such as Arnold Chiari Syndrome.  Counseling of the patient regarding participation in contact sports should be discussed in earnest.
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