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Neurological Disorders Provoked by Neck Movement
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Neurological disorders triggered by head and neck movement represent a diverse spectrum of conditions, ranging from benign and self-limiting to life-threatening pathologies. These disorders involve various mechanisms, such as compression, obstruction, or stretching of critical anatomical structures, and often present with a wide array of symptoms including vertigo, syncope, pain, or abnormal sensations.
Disorders
| Disorder | Characteristics | Key Symptoms | Management |
|---|---|---|---|
| Benign Paroxysmal Positional Vertigo (BPPV) | Debris in semicircular canals impeding fluid motion | Brief vertigo, nystagmus during positional changes | Epley or Semont maneuvers, avoid vestibular sedatives |
| Vertebrobasilar Insufficiency | Posterior circulation ischaemia, possibly due to arterial stenosis | Vertigo, ataxia, other brainstem or cerebellar symptoms | Secondary prevention (antiplatelets), avoid provocative movements |
| Bow Hunter Syndrome | Extrinsic compression of vertebral artery during neck rotation | Brainstem/cerebellar symptoms, syncope | Avoid provocative positions, surgical correction in severe cases |
| Bruns’ Syndrome | Mobile intraventricular mass obstructing CSF flow | Vertigo, headache, nausea/vomiting | Surgery, antiparasitic medications for neurocysticercosis |
| Cervical Vertigo | Controversial; disrupted proprioception from neck | Dizziness, vertigo | Diagnosis of exclusion, physiotherapy |
| Vestibular Paroxysmia | Compression of vestibular nerve, often by neurovascular conflict | Short vertigo attacks, triggered by head movement | Carbamazepine/oxcarbazepine, microvascular decompression if refractory |
| Carotid Sinus Hypersensitivity | Excessive vagal response to carotid baroreceptor stimulation | Syncope, bradycardia | Pacemaker for cardioinhibitory cases, avoid tight collars |
| Eagle’s Syndrome | Compression of carotid artery by elongated styloid process or ossified stylohyoid ligament | Oropharyngeal pain, TIA/stroke from carotid compression | Conservative management, surgical shortening if severe |
| Lhermitte’s Phenomenon | Spinal cord irritation, often in multiple sclerosis | Electric shock-like sensation radiating down spine | Treat underlying cause (e.g., MS) |
| Cervicogenic Headache | Neck pathology causing headache, e.g. C2/3 zygapophyseal joint pain | Unilateral headache, worse with neck movement | Physiotherapy, nerve blocks |
| Cervical Radiculopathy | Compression of cervical nerve roots | Neuropathic pain radiating to the arm | Analgesia, physiotherapy, decompression surgery for severe cases |
| Neck-Tongue Syndrome | Compression of C2 root and hypoglossal nerve | Neck pain with ipsilateral tongue sensation or posturing | Analgesia, physiotherapy, immobilisation collars |
| Cervical Arterial Dissection | Tearing in carotid or vertebral artery walls | Neck pain, Horner’s syndrome, TIA/stroke | Antiplatelets/anticoagulants, monitor for TIA/stroke |
| SSRI Withdrawal ‘Brain Zaps’ | Abrupt cessation of SSRIs | Shock-like sensations in head and neck | Gradual SSRI tapering, restart SSRI if severe |
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