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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].

Nasal Congestion
  • congestion History [ edit ] The syndrome was first described in 1925 by Jean Alexandre Barré , a French neurologist.[en.wikipedia.org]
Vascular Disease
  • For example there may be associated ligamentous strain, peripheral vascular disease or occult infection.[cme.dannemiller.com]
Ulcer
  • From Wikidata Jump to navigation Jump to search syndrome that involves occipital head aches, nystagmus on head movement, tinnitus, spasms, blurred vision, corneal hyperaesthesia, and corneal ulcers Cervicocranial syndrome Cervicocranial syndrome (disorder[wikidata.org]
  • […] syndrome Search Ontology: Synonyms: Cervicocranial syndrome Posterior cervical sympathetic syndrome Definition: A syndrome that involves occipital head aches, nystagmus on head movement, tinnitus, spasms, blurred vision, corneal hyperaesthesia, and corneal ulcers[zfin.org]
  • 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[symptoma.com]
  • A syndrome that involves occipital head aches, nystagmus on head movement, tinnitus, spasms, blurred vision, corneal hyperaesthesia, and corneal ulcers. [ ] Synonyms: Posterior cervical sympathetic syndrome, Cervicocranial syndrome, Posterior Cervical[ebi.ac.uk]
  • Aliases & Classifications for Barre-Lieou Syndrome Summaries for Barre-Lieou Syndrome Disease Ontology : 12 A syndrome that involves occipital head aches, nystagmus on head movement, tinnitus, spasms, blurred vision, corneal hyperaesthesia, and corneal ulcers[malacards.org]
Psychiatric Symptoms
  • Morinaka analyzed the frequency of musculoskeletal diseases in patients with cervical vertigo, as well as the relations of neck tenderness, psychiatric symptoms, and autonomic abnormalities (other symptoms beyond dizziness including irregular heartbeat[getprolo.com]
Vertigo
  • Together with a concomitant onset of dizziness, vertigo, visual disturbances and headaches, a presumptive diagnosis might be made.[symptoma.com]
  • […] the management of chronic neck pain and cervical vertigo.[getprolo.com]
  • […] separated by a space and hit enter Authors Source MeSH Autonomic Nervous System Diseases Disease Headache Humans Neurologic Manifestations Posterior Cervical Sympathetic Syndrome Spinal Diseases Spine Sympathetic Nervous System Tinnitus Vertebral Artery Vertigo[unboundmedicine.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]
Dizziness
  • Together with a concomitant onset of dizziness, vertigo, visual disturbances and headaches, a presumptive diagnosis might be made.[symptoma.com]
  • dizziness and associated neck pain.[getprolo.com]
  • Barré-Liéou syndrome - irritation of a nerve plexus around a vertebral artery produces symptoms of dizziness, headache, tinnitus.[medical-dictionary.thefreedictionary.com]
  • 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]
Neurologic Manifestation
  • Type your tag names separated by a space and hit enter Authors Source MeSH Autonomic Nervous System Diseases Disease Headache Humans Neurologic Manifestations Posterior Cervical Sympathetic Syndrome Spinal Diseases Spine Sympathetic Nervous System Tinnitus[unboundmedicine.com]
Involuntary Movements
  • These disorders can be explained by impaired cervical proprioception (a disruption in nerve signalling in the body’s unconscious or involuntary movements – pressure on the nerves) and neck movement limitations.[getprolo.com]

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]
  • Clinical aspects, radiology, pathogenesis, treatment].[unboundmedicine.com]
  • Talk with your doctor to find the best treatment if you or a loved one has been diagnosed with Barre Lieou syndrome .[diseaseinfosearch.org]
  • However our treatments differ significantly as we seek more of a curative effective in a short window of treatments and not prolonged care.[getprolo.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]

Prognosis

  • Poorer prognosis is likely if the neck is rotated at the time of impact.[blackberryclinic.co.uk]
  • 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]
  • Prognosis While spontaneous remission can occur in certain individuals, most experience unremitting, crippling, and irreversible pain.[cme.dannemiller.com]
  • Hohl M: Soft tissue injuries of the neck in automobile accidents: Factors influencing prognosis. J Bone Joint Surg 56A(8): 1675-1682, 1974. Macnab I: The "whiplash syndrome." Orth Clin N Amer 2(2): 389-403, 1971.[chiroweb.com]

Etiology

  • A1 - CLAISSE,R, PY - 1960/1/1/pubmed PY - 1960/1/1/medline PY - 1960/1/1/entrez KW - HEADACHE/etiology KW - NEUROLOGIC MANIFESTATIONS KW - SPINE/diseases KW - SYMPATHETIC NERVOUS SYSTEM/diseases KW - TINNITUS/etiology KW - VERTEBRAL ARTERY/diseases KW[unboundmedicine.com]
  • 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]
  • 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]
  • Bet2 iwas basically going to say what you said--that having this diagnosis doesn't exclude having fms. i feel that people can have different etiologies for their fms. for some, it may be genetic, for some a result of trauma, for some an emotional trauma[forums.prohealth.com]

Epidemiology

  • 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

  • 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]
  • Janig W: Pathophysiology of complex regional pain syndrome. Pain. 2005 an updated review. Seattle, ISAP Press. 2005;307-316. Janig W, Baron R: Complex regional pain syndrome is a disease of the central nervous system Clin Auton Res. 2002;12:150-164.[cme.dannemiller.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]
  • In other words: The neck is trying to restrict its own movement in much a same way a cervical collar works to prevent pain and symptoms of unstable vertebrae.[getprolo.com]
  • And despite all efforts from physio doesnt seem to be seeing improvments due the underlying rib causing alot of pain from the simplest of exercises, as well as seemingly preventing the scupla from fixing/realigning.[neckandback.com]
  • Furthermore it responds to treatment with Carvedilol, a medication that prevents the release of norepinephrine.[cme.dannemiller.com]
  • Well positioned head restraints do not prevent WAD type injury, although they have been shown in some studies to reduce the incidence and severity if positioned close to and level with the head.[blackberryclinic.co.uk]

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