Intracranial Hypertension and Concussion

Intracranial hypertension is a common brain condition that develops following a concussion or whiplash injury. In brief, IH occurs when there is an accumulation of cerebrospinal fluid (CSF) within the brain. It is linked with swelling of the brain tissue (aka chronic traumatic encephalopathy, CTE) and is associated with a variety of confounding symptoms:

• brain fog
• hormone dysfunction and dysautonomia
• digestive dysfunction
• chronic fatigue and chronic pain (e.g., fibromyalgia)
• blurry eyes
• headaches and migraines
• dizziness and vertigo

The Cause of Intracranial Hypertension

Historically, intracranial hypertension was known as “idiopathic intracranial hypertension” (IIH, which means “cause unknown”). It was attributed to either a) too much CSF production or b) insufficient CSF drainage. However, recent advances in MRI technology plus a common underlying mechanism (whiplash or concussion) suggests that the term “idiopathic” is not always appropriate.

Specifically, recent research is finding that intracranial hypertension can be linked to a mechanical misalignment of the craniocervical junction (where your skull meets the vertebrae in your upper neck). Here, the alignment of the C1 and C2 vertebrae in your neck can create a physical choke point (like a cork in a bottle) that disrupts normal fluid dynamics and can lead to an accumulation of CSF within the skull.

“I have an MRI. Why wasn’t this mentioned by the radiologist or neurologist?”

Radiologists and neurologists look for overt pathology such as cancer, bleeding, dislocations or lesions such as multiple sclerosis. In the absence of pathology, they commonly report that everything appears “normal.” However, they do not look for functional disrelationship such as what happens if there is ligament damage that affects the alignment of the C1 or C2 vertebrae.

It is not their fault, but simply a reflection of their scope of practice. Because concussion, whiplash and intracranial hypertension are functional neurological disorders, it means that they require a different approach to accurately diagnose.

What to look for on an MRI with Intracranial Hypertension

When it comes to complex conditions such as intracranial hypertension, it is worth emphasizing that there is no single piece to solving the whole puzzle. Instead, we have to consider how various pieces contribute toward solving the puzzle. That being the case, here are five things worth examining that suggest your upper neck could be contributing toward your symptoms.

1. Constriction of the Internal Jugular Veins.

The internal jugular veins exit the base of the skull directly alongside the outer tips of the C1 vertebra in your neck. If the C1 (atlas ) vertebra misaligns forward, it can impinge and narrow the internal jugular vein, which is the primary drainage pathway from your brain. This condition is sometimes also known as Eagle’s Syndrome when the nerves or arteries in the upper neck gets entrapped between the C1 vertebra and the styloid process (an extension of bone that attaches several muscles between your skull, jaw and hyoid bone).

2. Torsion of the Vertebral Arteries.

Mechanical misalignments of the C1 and C2 vertebrae can produce distortions of the normal course of the vertebral arteries that supply blood to your brainstem. This is a condition known as dolichoectasia. The brainstem (medulla and pons) is responsible for all your vital life functions including heart, lungs, and digestive system. Arteries also pulse. The problem can occur when these arteries are under tension, which causes them to pulse directly into the neural tissue. When this happens, this can produce a variety of symptoms ranging from trigeminal neuralgia to positional orthostatic tachycardia syndrome (POTS).

3. Damage to the Ligaments in the upper neck.

The ligaments that anchor your upper neck to the base of your skull are exceptionally strong. However, if you have ever experienced a whiplash injury, these ligaments can sprain. Even if they do not tear fully, they can contribute toward craniocervical instability. The ligaments in the upper neck contribute toward the normal circulation of CSF. Therefore, if they tear, they can change normal fluid dynamics and contribute toward intracranial hypertension.

4. Cerebellar Tonsillar Ectopia or Basilar Kyphosis.

There are certain pre-existing medical or hereditary conditions that include Chiari malformation, basilar kyphosis and basilar invagination that make certain people more susceptible to injury than others. If you have any of these conditions plus a whiplash injury, it is more likely that the cerebellum (balance and coordination center of the brain and body) can drop into the spinal canal and form a literal choke point for CSF circulation.

5. Torsion or friction against the spinal cord.

Your spinal cord is a small cylinder (about the diameter of your little finger). In other words, it should appear rounded on an MRI and located directly in the center of the spinal canal. If you see it shaped more like a football or abutting the edges of the vertebra, these are signs of spinal cord tension that can lead to conditions such as degenerative cervical myelopathy.

What to do for Intracranial Hypertension

We reiterate that there is no one-size-fits-all approach to solving intracranial hypertension. There are so many complex moving pieces that it would be folly to proclaim that we have found the missing piece of the puzzle. That said, what we have found with evidence of C1-C2 misalignment following a concussion or whiplash injury is an important piece to solving the puzzle … and one that is worth serious consideration.

Here is where a unique approach to healthcare known as Craniocervical Specific care can help.

Craniocervical specific (aka upper cervical specific) is a specialized form of chiropractic that does not use any twisting, cracking or stretching of the neck. Instead, it is a precise approach that uses advanced diagnostic imaging to determine the exact location, direction and degree of neck misalignment in order to provide a gentle and customized correction to help restore normal alignment, motion and stability in the joints of the upper neck. And as we’ve shown, by doing so we may be able to assist with restoring the normal flow and function of CSF within the brain, which can help people diagnosed with intracranial hypertension.