The Kimberly Anomaly
Kimerli anomaly is a disease characterized by the formation of a bone arch in the structure of the first cervical vertebra, which provokes restriction of the movement of the vertebral artery and its compression. Often this disease is a congenital malformation, but its acquired forms are also diagnosed. The pathology is accompanied by frequent dizziness, unsteadiness of gait, tinnitus, attacks of sudden weakness and loss of consciousness.
The content of the article:
Pathogenesis of vascular disorders in Kimberly anomaly
Classification of the Kimberly anomaly
Symptoms of the Kimberly anomaly
Diagnosis of the Kimberly anomaly
Treatment of the Kimberly anomaly
The Kimberly Anomaly
Kimberly’s anomaly in neurology is not considered a complex or serious pathology, therefore it does not require treatment. However, if the disease provokes compression of the vertebral artery, you cannot do without special treatment. In the case of severe manifestations of the Kimberly anomaly, the disease can cause chronic ischemia.
Pathogenesis of vascular disorders in Kimberly anomaly
To understand why the Kimberly anomaly is a serious pathology, it is necessary to first consider the structure of the spine. It is worth knowing that the left and right vertebral arteries depart from the subclavian arteries, and then pass along the cervical spine. At the same time, these arteries are located in the channel, which is formed due to the openings of the processes of the vertebra. Then the vertebral artery enters the occipital foramen and enters the skull.
The vertebral arteries, together with their branches, form the vertebral-basilar pool, which provides blood supply to the cerebellum, brain stem and spinal cord. These arteries also bend around the cervical vertebra, after which they pass through a wide bone furrow. If a patient has a Kimberly anomaly, a bone arch is formed above the bone furrow, which restricts the movement of the vertebral artery in this place.
Kimberly’s anomaly is almost always a congenital pathology. But it does not always provoke serious violations of the patient’s health. Usually, clinical manifestations of pathology that worsen the patient’s quality of life occur against the background of the following diseases:
vasculitis;
arterial hypertension;
atherosclerosis;
cervical spondyloarthrosis;
osteochondrosis of the cervical spine;
the presence of craniovertebral malformations;
traumatic brain injury;
scarring process;
spinal injury.
Classification of the Kimberly anomaly
A well-chosen method of treating the disease is largely due to its type. In neurology, it is customary to distinguish two main types of Kimberly anomaly. The first is characterized by the formation of a bony arch, which connects the process of the Atlas with the posterior arch. The second type of anomaly involves the presence of a bony arch located between the transverse and articular processes of the Atlas.
There are also complete and incomplete varieties of pathology. With a complete anomaly, the bone arch resembles a semicircle in its shape, and with an incomplete one, an arcuate outgrowth. The Kimberly anomaly can be localized both on both sides of the vertebra and on one side of it. It is also customary to distinguish acquired and congenital forms of the disease.
As for the acquired pathology of Kimberly, it is usually formed against the background of various chronic pathologies of the spine — for example, with osteochondrosis. In patients with an acquired anomaly, such a deformation of the furrow is usually observed, in which it is closed from above by a ligament.
The congenital anomaly of Kimberly is a consequence of malformations and does not pose a serious danger to the patient, therefore it does not require special treatment. On the contrary, the acquired form of the disease needs complex treatment, since it is characterized by pronounced symptoms that threaten the health and life of the patient. The most severe cases of the disease are accompanied by neurological disorders due to poor blood supply and compression of the spinal artery.
Symptoms of the Kimberly anomaly
Various manifestations of the disease, which cause severe discomfort to the patient, are usually provoked by a decrease in blood flow to the posterior parts of the brain. As a result of this pathological process, the patient has a noise in one or both ears. The nature of this noise can be different — hum, whistle, ringing, hissing. For the same reason, there is flickering or flickering in front of the eyes, as well as sudden darkening in the eyes.
Kimberly’s anomaly is characterized by a violation of the blood supply to the cerebellum, which leads to such clinical manifestations of the disease as frequent dizziness, impaired coordination and unsteadiness of gait. Usually, all these conditions only get worse when you turn your head. Constant overstrain of the muscles and an uncomfortable position of the head lead to the fact that the patient often loses consciousness. Another unpleasant symptom of the disease is the appearance of sudden muscle weakness, which leads to falls of the patient without prior loss of consciousness.
Severe cases of the disease are characterized by more complex and unpleasant symptoms. Patients with severe forms of Kimberly’s anomaly have such clinical signs of the disease as tremor of the hands and feet, headache, nystagmus, hypesthesia of the face or trunk, coordination disorders, motor disorders of the limbs. The most life-threatening complication is considered an ischemic stroke.
Diagnosis of the Kimberly anomaly
Kimberly’s anomaly is a serious neurological disease, the effective treatment of which depends on timely and accurate diagnosis. Of great importance in the diagnosis of pathology is the collection of anamnesis and neurological examination of the patient. Usually, patients go to the doctor with symptoms of the Kimberly anomaly, which indicate a violation of the circulatory process in the vertebro-basilar basin. The doctor prescribes first of all such diagnostic methods as radiography of the skull and spine. These techniques are very effective, because on lateral radiographs of the craniovertebral zone, the Kimberly anomaly is quite clearly visible.
If the patient complains of tinnitus, the doctor needs to exclude possible ENT diseases: cochlear neuritis, labyrinthitis, chronic otitis media. For this purpose, it is advisable to send the patient to an otolaryngologist for examination. Differential diagnostics also provides for various studies of hearing, such as experiments with tuning forks, speech, noise and tonal audiometry. Additionally, studies of the vestibular apparatus can be prescribed: electronystagmography, vestibulometry, stabilography.
Kimberly’s anomaly is not always provoked by vertebral artery syndrome, so the neurologist will need to exclude other causes of this pathological process during diagnosis. For example, with the help of contrast angiography, it is possible to detect compression of a vessel by such formations as a cyst, tumor, brain abscess, arterio-venous malformation, thrombosis, aneurysm of cerebral vessels.
Diagnosis of the disease also provides for determining the degree of its effect on blood circulation in the vertebral-basilar basin. This can be done with the help of additional studies such as transcranial Dopplerography, ultrasound of extracranial vessels, MRI and duplex scanning of cerebral vessels. All these instrumental techniques make it possible to determine the place of compression of the vertebral artery and disruption of its functioning, depending on the position of the neck and head.
Treatment of the Kimberly anomaly
Treatment of the Kimberly anomaly is not necessary in all cases. Indications for the appointment of treatment may be serious clinical symptoms of circulatory disorders provoked by the disease. Patients whose Kimberly anomaly caused vascular insufficiency are usually prescribed conservative treatment. In particular, vascular therapy is prescribed to improve cerebral blood flow, which involves taking medications such as cavinton, sermion, cinnarizine, devincan.
To improve the rheological parameters of the blood, trental and pentoxifylline are prescribed. Complex therapy of the disease also involves the use of neuroprotectors, antioxidants, nootropics and metabolic medications (ginkgo biloba, piracetam, mildronate, picamilon).
Surgical intervention
In most cases, the treatment of the Kimberly anomaly is limited to conservative methods and does not require surgical intervention. The need for surgery may be due to the decompensated manifestation of the vertebral artery syndrome, which provokes a serious violation of blood circulation in the vertebral-basilar basin. During surgery, the doctor performs mobilization of the vertebral artery and resection of the pathological arch. After the operation, the patient will need to undergo a rehabilitation period, during which he will have to wear a Trench collar for 2-4 weeks.
Additional measures
Patients who have been diagnosed with a mild form of Kimberly’s anomaly should definitely adhere to some precautions that will help them avoid serious complications. Namely, they need to avoid in every possible way sharp turns of the head, excessive physical exertion, performing physical exercises standing on their heads, as well as sports games and activities that are associated with head blows. Such activities include football, gymnastics, basketball and others.
Before a session of manual therapy or massage, the patient must necessarily warn the attending physician about the presence of a Kimberly anomaly. He should remember that in case of a sharp deterioration in his health, he needs to urgently consult a neurologist for advice so as not to miss the early stage of the disease and start his treatment on time.
