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Barre-Lieou Syndrome

Post Cervical Sympathetic Synd

Initially described in 1926 as the appearance of various head and neck complaints due to neck trauma and subsequent compression of the circulation around the third and fourth cervical vertebrae, Barre-Lieou syndrome is now rarely mentioned in the medical literature, and even disputed as a distinct clinical entity. A presumptive diagnosis can be made based on findings from the patient history and physical examination, as no other criteria for the diagnosis exist.


Presentation

Even though this clinical term was introduced in medical literature almost 100 years ago, the pathogenesis and exact clinical definition remain obscure. It is assumed that symptoms in Barre-Lieou syndrome arise due to the stimulation of sympathetic ganglia and fibers situated in the posterior areas of the C3 and C4 segments of the spine as a result of their protrusion after neck trauma [1] [2]. Consequently, vasoconstriction of the vascular system, principally of the vertebral artery, and dysfunction of the posterior plexus is proposed as the etiology of symptoms [3] [4]. Tinnitus, vertigo, and dizziness developing on the grounds of ischemia of the inner ear are some of the most common complaints reported in the literature, as well as headaches, blurred vision, nausea, vomiting and pupillary dilation [3] [4] [5] may also occur. Other reports have associated the onset of visual deficits (blurred vision, corneal hyperaesthesia, and corneal ulceration), swallowing and respiratory difficulties, as well as pain and cervical muscle spasm (primarily of the sternocleidomastoid muscle) with Barre-Lieou syndrome, but also anxiety, depression, and arrhythmias [1] [2]. However, more recent studies have disputed the pathogenesis and the resultant appearance of symptoms, as sympathetic stimulation seems to have a minimal effect on the vascular resistance [3]. Moreover, the mentioned symptoms can often be present in many patients due to various other reasons, which is why frequently Barre-Lieou syndrome is not referred to as a distinct term in medicine [3] [5].

Inguinal Hernia
  • Another right inguinal hernia repair with mesh. JD’s first appointment at Caring Medical was in August 2009. She had multiple complaints but her primary pain areas were the pelvic floor, pubis, groin, left knee and left ankle.[journalofprolotherapy.com]
Ear Fullness
  • Over this time, C.H. reported significant decreases in crepitation, blurry vision, migraines, and ear fullness.[article.sciencepublishinggroup.com]
  • On positional testing, after roughly a 20 second latency, she developed an extremely powerful right-beating nystagmus, which persisted as long as the head was turned to the left, and was accompanied by additional symptoms such as ear fullness, and at[dizziness-and-balance.com]
Vertigo
  • Together with a concomitant onset of dizziness, vertigo, visual disturbances and headaches, a presumptive diagnosis might be made.[symptoma.com]
  • Ringing in the ear (tinnitus), spinning (vertigo), or dizziness can occur.[getprolo.com]
  • She gets vertigo and stumbles and falls quite often. Her sinuses begin producing mucus and her right eye reddens (but not her left eye), and sometimes she says it feels as if the eye is being squeezed out of its socket.[medhelp.org]
  • Symptoms that characterize Barrà -Lieou syndrome are headache, facial pain, ear pain, vertigo, tinnitus, loss of voice, hoarseness, neck pain, severe fatigue, muscle weakness, sinus congestion, a sense of the eyeball being pulled out, and numbness.[braintalkcommunities.org]
  • PP clinical implications include cervicogenic migraine, vertigo, nausea, and the Barre-Lieou syndrome (10,13,15).[medical-dictionary.thefreedictionary.com]
Dizziness
  • Together with a concomitant onset of dizziness, vertigo, visual disturbances and headaches, a presumptive diagnosis might be made.[symptoma.com]
  • Ringing in the ear (tinnitus), spinning (vertigo), or dizziness can occur.[getprolo.com]
  • Barré-Liéou syndrome - irritation of a nerve plexus around a vertebral artery produces symptoms of dizziness, headache, tinnitus.[medical-dictionary.thefreedictionary.com]
  • Symptoms of Barre Lieou syndrome include migraines (headaches), ringing in the ears, dizzy spells, and ear and neck pain.[diseaseinfosearch.org]
  • RESULTS: Barré-Lieou syndrome includes very common symptoms--tinnitus, dizziness, and head or neck pain--attributed to ischaemia caused by cervical sympathetic nerve compression.[ncbi.nlm.nih.gov]

Workup

Because of the ambiguous interpretation of Barre-Lieou syndrome in medical practice, its diagnosis can be difficult to achieve. Having in mind the most important predisposing event - neck trauma [1] [4], a detailed patient history could identify injury or severe stretching of the neck. Together with a concomitant onset of dizziness, vertigo, visual disturbances and headaches, a presumptive diagnosis might be made. In addition, a detailed physical examination should be performed, with an emphasis on the range of motion of the head and neck area. Although plain radiography of the cervical spine is readily performed in the setting of neck-related injuries and associated symptoms, data regarding radiographic findings in patients suffering from Barre-Lieou syndrome are scarce, and rare reports have documented only a few patients demonstrating notable lesions (a tear drop fracture and ossification of the posterior longitudinal ligament) [4].

Treatment

  • Prolotherapy should be considered as a treatment for Barré-Liéou syndrome.[caringmedical.com]
  • Patient-centered treatment decisions were made on an individual basis. Every patient signed a consent form for treatment.[article.sciencepublishinggroup.com]
  • Most Treatments Provide Only Temporary Relief - There are several treatments which will relieve symptoms of the syndrome, but the effects are usually only temporary as the cause, the laxity of the ligaments, is not addressed and corrected.[healthandnutritiontips.net]
  • Barre Lieou syndrome can be caused by a whiplash event (where your head may snap back suddenly) and treatment usually involves exercises to strengthen the neck.[diseaseinfosearch.org]
  • P.: New results and complements of the technique of the uncusectomy in the treatment of the radicular and arterio-vertebral complications of cervicarthrosis. Rev. Chir. Orthop. 40, 135–154 (1966) Google Scholar 3.[link.springer.com]

Prognosis

  • Poorer prognosis is likely if the neck is rotated at the time of impact.[blackberryclinic.co.uk]
  • Prognosis For most cases the prognosis is good, however recalcitrant cases of Barre-lieou are common place. There is a tendency for symptoms to improve over time, but it can take years.[wikidoc.org]
  • Guillain–Barré syndrome: pathogenesis, diagnosis, treatment and prognosis. Nature Reviews Neurology , vol 10. doi:10.1038/nrneurol.2014.121. Available online at through . Accessed August 21, 2015.[labtestsonline.it]
  • The prognosis for full recovery is good. Guillain-Barré syndrome affects primarily the ventral roots of the spinal cord, hence the motor disturbances.[medical-dictionary.thefreedictionary.com]
  • Prognosis While spontaneous remission can occur in certain individuals, most experience unremitting, crippling, and irreversible pain.[cme.dannemiller.com]

Etiology

  • Consequently, vasoconstriction of the vascular system, principally of the vertebral artery, and dysfunction of the posterior plexus is proposed as the etiology of symptoms.[symptoma.com]
  • Due to the overlap in symptomatology between these conditions, a common etiology such as underlying cervical instability should be considered.[article.sciencepublishinggroup.com]
  • While traction injuries (as in whiplash) to the posterior cervical chain are the most common etiology, other causes include local trauma, chronic infection and coagulopathy.[cme.dannemiller.com]
  • “Osteoarthritis of the cervical portion of the vertebral column was found to be the most frequent single etiologic factor underlying the posterior cervical sympathetic syndrome.”[chiro-trust.org]
  • .), etiology and pathophysiology (what causes it), signs and symptoms, associated findings, diagnosis, treatment, and prognosis. (MORE) Stephens-Johnson syndrome is a life threatening condition thataffects the skin.[answers.com]

Epidemiology

  • Causes Common Causes Traumatic flexion-extension movement Complete List of Causes in Alphabetical Order Autoimmune disorders Gunshot wounds Head trauma Infection Traumatic flexion-extension movement Epidemiology and Demographics Barre Lieou syndrome is[wikidoc.org]
  • Epidemiology . Its incidence is reported as 0.2-0.6% of all pregnancies. Of women with (pre)eclampsia, 4-12% also develop signs of a "superimposed" HELLP syndrome. Mortality is 7-35% and perinatal mortality of the child may be up to 40%.[answers.com]
  • Epidemiologi Forekomsten av cervikogen hodepine er vanskelig å anslå, siden tilstanden har hatt mange ulike definisjoner.[tidsskriftet.no]
  • Allen G, Galer BS, Schwartz L: Epidemiology of complex regional pain syndrome: A retrospective chart review of 134 patients. Pain. 1999;80:539-544.[cme.dannemiller.com]
Sex distribution
Age distribution

Pathophysiology

  • Pathophysiology It has been hypothesized to be due to a traction injury of the posterior cervical sympathetic chain in association with musculoskeletal injury of the head or neck.[wikidoc.org]
  • Pathophysiology . The exact cause of HELLP is unknown, but general activation of the coagulation cascade is considered the main underlying problem. Fibrin forms crosslinked networks in the small .[answers.com]
  • Haldeman, S: The Pathophysiology of the Spinal Subluxation. In Goldstein M (ed): The Research Status of Spinal Manipulative Therapy. Washington, DC, Government Printing Office, NINCDS Monograph No. 15 DHEW Publication No.[chiro.org]
  • Pathophysiology Autopsy studies have shown that in severe whiplash, damage is caused by the sheer force to bone, joints, ligaments, muscles and nerves.[blackberryclinic.co.uk]
  • Barkhoudarian G, Hovda DA, Giza CC: The molecular pathophysiology of concussive brain injury. Clin Sports Med 2011, 30(1):33-48. Swinkels RA, Oostendorp RA: Upper cervical instability: fact or fiction? J Manipul Physiol Therap 1996,19(3):185-194.[article.sciencepublishinggroup.com]

Prevention

  • Since the patient worked at a restaurant, it was imperative for him to wear a hard collar during the day to prevent excess rotation or flexion of his neck as he moved around the kitchen, as well as to prevent self-manipulation.[caringmedical.com]
  • Center for Disease Control and Prevention: Injury Prevention and Control: Traumatic Brain Injury. Atlanta, GA: Center for Disease Control and Prevention; 2013. . Sports Concussion Institute: Concussion Facts.[article.sciencepublishinggroup.com]
  • . / World Society of Pain Clinicians 2004 303 Abortive and Preventive Effects on Chronic Headache Mizokami, T. / World Society of Pain Clinicians 2004 309 Distribution of Vanilloid, Purinergic and Serotonergic Receptors in the Trigeminovascular System[tib.eu]
  • Prevention Because so little is known about what causes GBS to develop, there are no known methods of prevention. Resources Organizations American Academy of Neurology. 1080 Montreal Ave., St. Paul, MN 55116. (612) 695-1940. .[medical-dictionary.thefreedictionary.com]
  • Special medications to help prevent bone destruction in cases of rheumatoid arthritis may be needed.[necksolutions.com]

References

Article

  1. Pearce J. Barré-Liéou “syndrome.” J Neurol Neurosurg Psychiatry. 2004;75(2):319.
  2. Longbottom J. A case report of postulated 'Barré Liéou syndrome'. Acupunct Med. 2005;23(1):34-38.
  3. Li Y, Peng B. Pathogenesis, Diagnosis, and Treatment of Cervical Vertigo. Pain Physician. 2015;18(4):E583-595.
  4. Tamura T. Cranial symptoms after cervical injury. Aetiology and treatment of the Barré-Liéou syndrome. J Bone Joint Surg Br. 1989;71(2):283-287.
  5. Foster CA, Jabbour P. Barré-Lieou syndrome and the problem of the obsolete eponym. J Laryngol Otol. 2007;121(7):680-683.

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Last updated: 2017-08-09 14:34