The brainstem compression diagnosis, how to do it?

[Cherry]

This is so interesting. Thanks

 

[gbells]

I found an online reference for how MDs diagnose CCI.

https://www.merckmanuals.com/profes...alities/craniocervical-junction-abnormalities

Diagnosis

• MRI or CT of the brain and upper spinal cord

A craniocervical abnormality is suspected when patients have pain in the neck or occiput plus neurologic deficits referable to the lower brain stem, upper cervical spinal cord, or cerebellum. Lower cervical spine disorders can usually be distinguished clinically (based on level of spinal cord dysfunction) and by neuroimaging.
Neuroimaging
If a craniocervical abnormality is suspected, MRI or CT of the upper spinal cord and brain, particularly the posterior fossa and craniocervical junction, is done. Acute or suddenly progressive deficits are an emergency, requiring immediate imaging. Sagittal MRI best identifies associated neural lesions (eg, medulla, pons, cerebellar, spinal cord, and vascular abnormalities; syringomyelia) and soft-tissue lesions. CT shows bone structures more accurately than MRI and may be done more easily in an emergency.
If MRI and CT are unavailable, plain x-rays—lateral view of the skull showing the cervical spine, anteroposterior view, and oblique views of the cervical spine—are taken.
Atlantoaxial Subluxation

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If MRI is unavailable or inconclusive and CT is inconclusive, CT myelography (CT after intrathecal injection of a radiopaque contrast agent) is done. If MRI or CT suggests vascular abnormalities, magnetic resonance angiography or vertebral angiography is done.