Symptoms of Cerebellar Herniation: Headaches, Dizziness, and Neck Pain

Q: Symptoms of Cerebellar Herniation: Headaches, Dizziness, and Neck Pain

Hello, Miss： In addition to your original issues, we may need to consider vascular headaches, which could be related to your menstrual cycle. <br>Furthermore, since you mentioned a connection to posture, we should consider "intracranial hypotension headache." The primary symptom

Dizziness, headache, and tightness and pain in the shoulder and cervical spine?

Hello, doctor.
I started experiencing severe headaches, dizziness, neck tightness and pain, and numbness in my hands and feet around July of last year.
I initially thought it was due to fatigue or heatstroke, so I didn't pay much attention to these symptoms.
In October and November, I suddenly had difficulty breathing, and my limbs, face, and tongue felt numb and weak.
After visiting the emergency room and then the neurosurgery outpatient clinic for examination, an MRI revealed that I have "cerebellar prolapse," which the doctor said is a rare condition that could be caused by external trauma or may be congenital.
I initially chose conservative physical therapy, but the doctor mentioned that if my condition did not improve, surgery would be necessary.
Unfortunately, the rehabilitation was not effective, and my headaches and numbness worsened.
After surgery in December, I have been in recovery, but I have continued to experience discomfort.
In February, I suddenly had severe headaches, with tightness and burning sensations at the back of my head and neck incision.
After a follow-up CT scan in early March, the doctor said that the inner layer from my surgery was just beginning to heal and scab over.
The burning sensation gradually diminished, but I still felt tightness, along with sudden pain and dizziness.
When I returned for a check-up at the end of June, I explained my current condition, but recently I have felt not only tightness and swelling from my head to my shoulders but also nausea from the headaches.
I have been experiencing dizziness and weakness, with persistent sharp pain and numbness in my cervical spine.
However, the doctor said that all tests in March were normal and advised me to rest and not overexert myself, assuring me not to worry.
But for the past week, I have often felt a floating dizziness, with occasional difficulty focusing my eyes and a general sense of weakness.
After resting for a while, I would return to normal… I feel stiffness in my neck every day, and the area just above my neck feels numb and swollen.
A few days ago, while squatting, I suddenly felt a vibration in my head and became dizzy.
I would like to ask the doctor if I need to undergo any further examinations.
I originally thought that after surgery, I would only need a few months of recovery to fully heal and would not experience headaches or dizziness again.
Now, these symptoms occur almost daily, making me feel very uncomfortable and distressed.

Ke Ke, 30~39 year old female. Ask Date: 2021/07/09

Dr. Jiang Junyi reply Neurology

Hello, Miss: In addition to your original issues, we may need to consider vascular headaches, which could be related to your menstrual cycle.
Furthermore, since you mentioned a connection to posture, we should consider "intracranial hypotension headache." The primary symptom of intracranial hypotension is "postural headache," where the headache worsens when standing or sitting and significantly improves or disappears when lying down.
The more common type is bilateral, non-pulsating headache, and performing the Valsalva maneuver (holding your breath and straining) can exacerbate the headache.

In addition to headaches, other symptoms often accompany postural headaches, and some patients may seek medical attention primarily due to these non-headache symptoms.
Neck pain or stiffness is common, often starting in the neck but may extend downwards, even causing lower back pain.
Nausea and vomiting are frequently associated, often related to changes in posture.
Diplopia is common, typically due to unilateral or bilateral abducens nerve palsy, with occasional cases of oculomotor or trochlear nerve palsy.
Auditory symptoms may include echo, sounds becoming distant or unclear, tinnitus, or even hearing loss.
Visual symptoms primarily involve blurred vision and photophobia.
I recommend that you consult a neurologist at the same hospital, as physicians from the Taiwan Headache Society are more familiar with these conditions.
Please ensure to practice self-protection, maintain cleanliness and disinfection, and adhere to new pandemic prevention measures before and after your medical visit.
Thank you for your inquiry, and feel free to discuss any related questions! Wishing you good health, peace, and happiness.

Dr.
Jiang Junyi, Department of Neurology, Taoyuan Hospital, cares about you.

Reply Date: 2021/07/09

More Info

Your symptoms of severe headaches, dizziness, neck pain, and numbness in your limbs, especially following your diagnosis of cerebellar herniation (also known as Chiari malformation), are concerning and warrant further evaluation. Cerebellar herniation occurs when the cerebellum, the part of the brain that controls balance and coordination, protrudes through the foramen magnum at the base of the skull. This condition can lead to a variety of neurological symptoms due to pressure on the brainstem and spinal cord.

The symptoms you describe, including severe headaches, neck stiffness, and episodes of dizziness, can be attributed to several factors related to your condition. After surgery, it is not uncommon for patients to experience ongoing symptoms as the body heals. However, the persistence and worsening of your symptoms, such as the feeling of tightness in the neck, sudden pain, and episodes of dizziness, suggest that further investigation may be necessary.

1. Post-Surgical Recovery: After surgery for cerebellar herniation, it is crucial to monitor recovery closely. The healing process can vary significantly among individuals. While some may experience relief from symptoms, others may continue to have headaches and neck pain due to residual tension or muscle spasms in the neck and upper back. Physical therapy focusing on neck and shoulder relaxation may be beneficial.

2. Neurological Evaluation: Given your ongoing symptoms, it would be prudent to follow up with your neurologist or neurosurgeon. They may recommend additional imaging studies, such as an MRI or CT scan, to assess the surgical site and ensure there are no complications, such as fluid accumulation (cerebrospinal fluid leaks) or scar tissue formation that could be contributing to your symptoms.

3. Physical Therapy: Engaging in physical therapy can help address muscle tightness and improve neck mobility. A physical therapist can provide exercises tailored to your specific needs, focusing on strengthening the neck muscles and improving posture, which may alleviate some of the discomfort you are experiencing.

4. Medication Management: If your headaches are severe and accompanied by nausea or vomiting, discussing medication options with your healthcare provider is essential. They may prescribe medications to help manage pain and prevent headaches, as well as address any potential anxiety or stress that may be exacerbating your symptoms.

5. Lifestyle Modifications: Incorporating stress management techniques, such as mindfulness, yoga, or gentle stretching, may help reduce muscle tension and improve your overall well-being. Ensuring adequate hydration, nutrition, and sleep can also play a significant role in recovery.

6. Monitoring Symptoms: Keep a detailed log of your symptoms, including their frequency, duration, and any potential triggers. This information can be invaluable for your healthcare provider in determining the best course of action.

In summary, while it is not uncommon to experience ongoing symptoms after surgery for cerebellar herniation, the persistence and severity of your symptoms warrant further evaluation. It is essential to maintain open communication with your healthcare team and advocate for the necessary tests and treatments to address your concerns. Your health and comfort are paramount, and with the right approach, there is potential for improvement in your symptoms.

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