Greater Occipital Neuralgia: An Unusual Presenting Feature of Neurosyphilis

Abstract

SYNOPSIS The syndrome of greater occipital neuralgia (GON) is a cause of chronic unilateral or bilateral headaches. It occurs when the greater occipital nerve is compressed, irritated or inflamed. We describe a case of neurosyphilis in which GON was the presenting manifestation. We discuss this previously unreported early presenting feature of neurosyphilis and its implication.

Occipital neuralgia secondary to hypermobile posterior arch of atlas

“…4,5,7,15,17 Nausea, dizziness, vertigo, stiff neck, photophobia, and blurred vision may also be experienced, 7,18 as may tenderness of the greater occipital nerve as it crosses the nuchal line. 4,7,9,12,15 The greater occipital nerve is formed by the medial branch of the C-2 dorsal ramus, with contributions from the C-1 and C-3 nerve roots. 1,4,6 Whereas lesions of C-3 may cause occipital pain, those affecting C-4 and below are much less likely to do so.…”

“…[9][10][11]18 Other implicated causes of occipital neuralgia include trauma-induced scars, fracture pseudarthrosis, neurosyphilis, degenerative joint disease, primary and metastatic tumors, Chiari malformation, fibrositis, myositis and temporal arteritis, and vascular compression caused by an anomalous vertebral artery. 2,[4][5][6]8,[13][14][15] Nonsurgical therapy includes oral analgesics, anticonvulsants, antibiotics, 15 cervical collars, 4,6 cervical traction, 7 electrical nerve stimulation, 4,7 heat, massage, 8 and injections of local anesthetics or neurolytic agents. Injections are given at the area of greatest tenderness along the nuchal line or at the atlantoaxial joint.…”

Occipital Neuralgia As a Presenting Symptom of Cervicomedullary Dural Arteriovenous Fistula

“…Suggested causes include trauma, injury, inflammation, or compression at a peripheral nerve or radicular level 7,8 . Rarely patients with ON secondary to cervical cord lesions, such as an upper cervical cord cavernous angioma, neurosyphilis, and myelitis have been reported 7–10 . In the case presented, the patient's occipital headache would fit the current International Headache Society's criteria for ON, 6 although effect of anesthetic blockade on the pain was unknown.…”

Third Occipital Nerve Entrapment

“…The advantage of the prone technique is that the radiofrequency lesioning technique (see below) is done in a similar manner. [ 14 ] Cognitive dysfunction, ataxia, sensory disturbance, +RPR Zygapophysial joint dysfunction Pain with neck extension or rotation Temporal arteritis [ 15 ] Fever, elevated ESR and CRP Vertebral artery dissection/ compression [ 16 ] Horner's syndrome C2 myelitis [ 17 ] Loss of function in C2 distribution C2-C3 intervertebral disk dysfunction Radiating pain from the neck into the shoulder Atlantoaxial joint dysfunction [ 18 ] Suboccipital pain, focal tenderness over the transverse process of C1, restricted head rotation with pain …”