occipital pain
Introduction
Introduction Frequent occipital pain is mostly associated with insufficient blood supply to the vertebral basilar artery, and the cause of it is mainly cervical spondylosis. The basic pathological change of cervical spondylosis is the degeneration of the intervertebral disc. Its main symptoms are sore head, neck, shoulders, back, arms, neck and neck, and limited mobility. Neck and shoulder pain can be radiated to the head and upper parts of the head, some with dizziness, house rotation, severe with nausea and vomiting, bedridden, a few can have dizziness, tripping. The cervical vertebra is located between the skull and the thorax. The cervical disc has frequent activities under load-bearing conditions and is susceptible to excessive micro-injury and strain.
Cause
Cause
1. The basic pathological change of cervical spondylosis is the degeneration of the intervertebral disc. The cervical vertebra is located between the skull and the thorax. The cervical disc has frequent activities under load-bearing conditions and is susceptible to excessive micro-injury and strain.
2, the main pathological changes are: early cervical disc degeneration, medullary nucleus water content and fiber ring fiber swelling, thickening, followed by glassy degeneration, and even rupture. After cervical disc degeneration, the pressure resistance and tensile strength are reduced. When subjected to the gravity of the skull and the pulling force of the muscles of the head and chest, the degenerated disc can undergo localized or extensive bulging to the periphery, narrowing the intervertebral disc space, overlapping the articular processes, dislocation, and the longitudinal diameter of the intervertebral foramen. Become smaller. As the traction resistance of the intervertebral disc becomes weaker, when the cervical vertebra moves, the stability between adjacent vertebrae decreases and the intervertebral instability occurs, the mobility between the vertebral bodies increases and the vertebral body has a slight slippage, which then appears Bone hyperplasia of the posterior facet joint, hook joint and lamina, degeneration of the ligamentum flavum and ligament, cartilage and ossification.
3, because the cervical disc is bulging around, the surrounding tissue (such as the anterior and posterior longitudinal ligament) and the vertebral periosteum can be picked up, and a gap is formed between the vertebral body and the protruding intervertebral disc and the ligament tissue that is picked up, called "ligament Intervertebral disc space, in which the accumulation of tissue fluid, coupled with the bleeding caused by micro-damage, makes this bloody fluid mechanized and then calcified, ossified, thus forming the epiphysis.
The relaxation of the anterior and posterior ligaments of the vertebral body makes the cervical spine unstable, which increases the chance of trauma and gradually increases the callus. The epiphysis together with the bulging annulus fibrosus, the posterior longitudinal ligament and the edema or fibrous scar tissue caused by the traumatic reaction, forming a mixture in the spinal canal at the site corresponding to the intervertebral disc, may exert an oppressive effect on the spinal nerve or the spinal cord. The epiphysis of the hook joint can protrude from the anterior to the posterior to the intervertebral foramen to compress the nerve root and the vertebral artery. The epiphysis of the anterior border of the vertebral body generally does not cause symptoms, but there are reports of such anterior epiphysis affecting swallowing or hoarseness in the literature. After the spinal cord and nerve roots are compressed, they are only functional changes at the beginning. If the pressure is not relieved in time, it will gradually produce irreversible changes. Therefore, if non-surgical treatment is ineffective, surgery should be performed promptly.
4, the pathogenesis of cervical spondylosis:
(1) Degenerative changes of the cervical spine.
(2) Trauma factors.
(3) Chronic strain.
(4) Cold and humid.
Additional instructions:
Cervical spondylosis is mainly caused by degenerative changes in the cervical disc and cervical vertebrae and their accessory structures.
The pathogenesis of cervical spondylosis, like lumbar disc herniation, cannot be explained by mechanical compression alone, and vascular and chemical factors are at work, causing edema and inflammation or aggravating neurological symptoms.
Examine
an examination
Related inspection
Spinal MRI examination of cervical CT
The symptoms of cervical spondylosis are very rich, diverse and complex. Most patients begin to have milder symptoms, which gradually worsen later, and some of them have more severe symptoms. This is related to the type of cervical spondylosis, but often the type is simple, with one type as the main cum and one to several types mixed together, called mixed cervical spondylosis, so the symptoms are very rich and diverse. complicated.
Its main symptoms are sore head, neck, shoulders, back, arms, neck and neck, and limited mobility. Neck and shoulder pain can be radiated to the head and upper parts of the head, some with dizziness, house rotation, severe with nausea and vomiting, bedridden, a few can have dizziness, tripping. Some of the face is hot, and sometimes sweating is abnormal. The shoulders and back are heavy, the upper limbs are weak, the fingers are numb, the skin of the limbs is weakened, the grip is weak, and sometimes the unconscious grip falls.
Other patients have weak limbs, unstable walking, numb feet, and feeling like walking cotton when walking. When cervical spondylosis involves sympathetic nerves, dizziness, headache, blurred vision, dilated eyes, dry hair, open eyes, tinnitus, ear block, balance disorder, tachycardia, palpitation, chest tightness, There are even symptoms such as flatulence. A small number of people have large, urinary out of control, sexual dysfunction, and even quadriplegia. Also have difficulty swallowing, dysphonia and other symptoms. These symptoms have a certain relationship with the degree of onset, the length of onset, and the physical condition of the individual. Most of them are light and not taken seriously by people. Most of them can recover on their own, and they are light and heavy. Only when the symptoms continue to increase and cannot be reversed, it will only attract attention when it affects work and life. If the disease is cured for a long time, it will cause psychological damage, resulting in insomnia, irritability, anger, anxiety, depression and other symptoms.
Diagnosis
Differential diagnosis
Differential diagnosis of occipital pain:
First, nerve root type cervical spondylosis needs to be identified with the following diseases:
1. Cervical rib and anterior scalene muscle syndrome: The patient is younger, mainly characterized by dry compression under the brachial plexus, numbness of the medial extremities, atrophy of the intermuscular muscles and interosseous muscles. Because the subclavian artery is often compressed at the same time, the affected limb is pale and cool, and the radial artery beats weakened or disappeared. The Adson test (head turned to the affected side, temporary aspiration after deep inhalation, brachial artery beat weakened or disappeared) was positive. The neck film can confirm the neck ribs.
2. Intraspinal extramedullary subdural tumors, intervertebral foramen and peripheral neurofibromatosis, and tumors near the lung tip (Pancoast tumor) can cause upper limb pain. Cervical radiographs may reveal signs of lesions in the spinal canal and enlargement of the intervertebral foramen without cervical degenerative changes. CT or MRI can directly display tumor images, and Pancoast tlamor patients are also accompanied by Horner's syndrome.
3. Neuropathic muscle atrophy: often involving the C5 distribution area, causing severe pain, shoulder muscle weakness and atrophy. However, the sensory disorder is mild, the symptoms often relieved quickly, and generally do not involve the neck.
4. angina pectoris: pain can be radiated to the upper limbs and shoulders and neck, but mostly episodes, oral nitroglycerin tablets can be relieved, patients have a history of coronary heart disease, generally not difficult to identify.
5. Tendon sleeve syndrome: mainly manifested as shoulder abduction weakness and abduction more than 30. In the later pain, there is tenderness in the tendon, which is different from nerve root pain.
6. Rheumatic polymyalgia: similar to brachial plexus neuralgia, but without dyskinesia.
Second, cervical spondylotic myelopathy should be identified with the following diseases:
1. Amyotrophic lateral sclerosis: mainly with spastic quadriplegia, no sensory disturbance, and often invades the medulla and causes the lower cranial nerve symptoms.
2. Multiple sclerosis: Symptoms of brain and spinal cord often occur at the same time, and bladder dysfunction occurs before limb dyskinesia.
3. Intraspinal tumor: can occur at any age, the symptoms develop faster. Various imaging examinations are helpful for identification.
4. Spiral stenosis: mainly manifested as sensory disturbances, and dyskinesias appear later. MRI can clearly show the thickening of the central canal of the spinal cord.
