Conditions associated with the foramen magnum syndrome:
(1) meningioma
(2) neurofibroma
(3) glioma
(4) metastasis
(5) bone tumor
Clinical findings:
(1) neck pain and stiffness and/or occipital headache
(2) pain radiating into the shoulder
(3) spastic weakness in upper and/or lower extremities
(4) sensory loss below the head in various combinations, including numbness in arms and/or legs, dissociated (some lost while other preserved), pseudoathetosis, hemisensory, etc.
(5) gait disturbance
(6) clumsiness in the use of the hands
(7) hemiparesis or quadriparesis
(8) muscle atrophy in one or both upper extremities
(9) downbeating nystagmus with eyes in primary position or in lateral gaze
(10) electric shock-like feeling that runs down the spine
Some patients may develop dysarthria, dysphonia and/or dysphagia due to cranial nerve involvement.
MRI is the preferred imaging method for making the diagnosis.
Differential diagnosis:
(1) syringomyelia
(2) multiple sclerosis
(3) Chiari malformation
(4) cervical spondylosis
(5) atlantoaxial subluxation
(6) transverse myelitis
(7) tumor of the upper cervical spinal cord
