Occipital Neuralgia as an Isolated Symptom of C2 Myelitis

Abstract

Occipital neuralgia has been attributed to lesions at a peripheral nerve or radicular level. On rare occasions, it has been associated with cervical cord lesions. We report a 55-year-old woman who presented with an isolated occipital neuralgia and was found on further investigation to have a restricted, isolated myelitis at C2 level. This represents the second reported case of occipital neuralgia due to C2 myelitis and should alert clinicians to considering cervical MRI in patients with occipital neuralgia.

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.…”

“…It is important to consider underlying causes of occipital pain when diagnosing ON. 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 .…”

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 …”

Fluoroscopy and Sonographic Guided Injection of Obliquus Capitis Inferior Muscle in an Intractable Occipital Neuralgia

“…Occipital neuralgia may be caused by an anatomical pathological process that occurs in connection with nerve roots of the upper cervical spine [1] and may rarely be caused by dural arterio-venous fistula of spine head joints [2], cavernous angioma of hindbrain [3], tumor [4,5], and herpes zoster virus infection [6-9]. …”