Craniocervical Syndromes, EDS and MS

Annotated Sagittal T1 Midline MRI Scan of Reig...

Image by Reigh LeBlanc via Flickr

There are many different types of inherited and acquired disorders, as well as degenerative conditions (aging and wear and tear) of the cervical spine, especially the upper cervical spine (skull and upper cervical spine). I refer to them as craniocervical syndromes in my book.  Craniocervical syndromes can cause and array of neurological signs and symptoms related to the brain and cord.

Craniocervical syndromes cause problems by compressing blood and cerebrospinal fluid pathways going into and out of the brain and cord. They can also cause compressive myelopathy of the cervicomedullary cord; which is compression of the lower brainstem and upper cord. Craniocervical syndromes can thus cause an array of signs and symptoms.

In the brain scan above the cauliflower looking structure, at the lower rear part of the brain, is the cerebellum. In front of and below the cerebellum is a verticle tube-like structure which is the brainstem and cord. At the top of the tube-like structure is a round protruding belly-like part of the brainstem in front of the cerebellum called the pons. Above the pons is the midbrain of the brainstem and below it is the medulla oblongata which is the lowest part of the brainstem that connects to the highest part of the spinal cord. Pons is the Latin word for bridge. The pons was called a bridge because it links the midbrain, cerebellum and medulla of the brainstem together.

In front of the pons and behind a black circular structure (the sphenoid sinus) is a white triangular shaped structure with what could be described as a white cup at the very top.  The structure is the clivus of the base of the skull. The cup is the compartment in the skull that contains the pituitary gland, which is the master gland that controls the endocrine system. The very bottom of the clivus is the front side of the foramen magnum. This is a large opening in the base of the skull to accommodate the brainstem and cord. Across from it and under the cerebellum (cauliflower) is a thin white strip which is part of the occipital bone that forms the rear of the foramen magnum.

Just below the bottom of the clivus on the front side of the foramen magnum is a white peg-like structure with a black line shaped like a cap over it. The peg-like structure is the dens or odontoid part of the second cervical vertebra below the skull. The dens sits in a pocket of the atlas or first cervical vertebra. The dens is a pivot joint for left and right rotation of the neck. The black line, in front and back of the dens, is fluid that lubricates the joint. A ligament holds the dens in place inside the atlas formed pocket and keeps it from moving posteriorly (back) causing it to compress the spinal cord.

The cerebellum sits in its own compartment called the posterior fossa.  The dark shadow above the cerebellum is the tent-like covering over the posterior fossa called the tentorium cerebelli. The covering is not flat but angles upward. There is a whole in the covering called the incisura for the brainstem to pass through to the foramen magnum and cord below. In the graphic picture on the left, the green area is the right half of the tentorium cerebelli that covers the cerebellum in the posterior fossa below. It divides the brain into upper and lower comparments. The light red area represents the falx cerebri, which is a vertical curtain of connective tissue similar to the tentorium that divides the brain into left and right halves. A similar vertical curtain of connective tissue, called the falx cerebelli, also separtes the posterior fossa and cerebellum into left and right sides.

The posterior fossa and upper cervical spine are critical to blood and CSF flow and contain some of the most crucial components of the brain and cord. Many conditions affect the upper cervical spine and base of the skull predisposing humans to neurodegenerative conditions and subsequent diseases. This is due to the unique design of the skull, spine and circulatory system of the brain and cord as a result of upright posture.

One genetic condition in particular underscores the role of craniocervical syndromes in neurodegenerative conditions due to it’s design flaws.  That condition is Ehlers-Danlos syndrome or EDS. Even the short version of EDS is far too long to discuss here but is discussed on my website. In brief, certain cases of Ehlers-Danlos Syndrome (EDS) affect the design of the skull and some affect the upper cervical spine resulting in Chiari malformations and hydrocephalus type condtions among other things.

I will discuss other craniocervical syndromes that can cause similar problems as the website develops. The design of the base of the skull and upper cervical spine needs to be studied much further. It may be a key culprit in many neurodegenerative conditions. Upright MRI will shed much more light on this in the future.

For additional information on this and other related topics as well as my book go to my website at

About uprightdoctor

I am a sixty year old retired chiropractor with considerable expertise in the unique designs of the human skull, spine and circulatory system of the brain due to upright posture, and their potential role in neurodegenerative diseases of the brain and cord. I have been writing about the subject for well over two decades now. My interests are in practical issues related to upright posture and human health.
This entry was posted in ccsvi, chiari malformations, Devic's disease, Ehlers Danlos Syndrome, multiple sclerosis, optic spinal multiple sclerosis, physical anthropology and tagged , , , , , , , . Bookmark the permalink.

7 Responses to Craniocervical Syndromes, EDS and MS

  1. mhirzel says:

    Dear Dr. Flanagan,

    I have just finished reading your FASCINATING book. Thank you!

    I have a question that I feel certain I should (but don’t) know the answer to. Which is:

    You are saying that, in the case of misalignment of C1, C2, drainage problems may be corrected via upper cervical work INSTEAD OF angioplasty/”liberation”?


  2. Brilliant Dr. Dr. Flanagan wish I had you in school teaching me osteology and upper cervical neurology. You make challenging topic of study clearly understood.

    Are you finding properly taken upright MRI’s provide clear enough imaging to properly asses developmental abnormalities in order to make specific adjustment/corrections?

    Looking forward to more on EDS.

  3. Anne Marie says:

    I’ve been suffering from neck & occipital pain for just about as long as you’ve been writing (2 decades!)… To add insult to injury, I slipped backwards on black ice, landed on my rear but the momentum caused me to slam the back of my head on the ice too. I couldn’t believe how loud hitting my head was! I wasn’t surprised that my scalp bled a little where it hit the ice, but I WAS surprised that my left jaw (below my left ear hurt) hurt like I’d been punched in the jaw! The ER MD said I have a LOT of arthritis in my neck, didn’t see any jaw Fx and so recommended I take a few days off of work. The following morning I couldn’t balance my head on my neck: when I went to sit back in a chair, I thought my head was gonna roll off my neck & down my back, like I didn’t have any neck musles (like a newborn!). Since the pain is now chronic, my Pain Mngt MD says the 3 lumps which have never gone away since the accident (which are adjacent to each spiney prominance in my neck) are muscle spasms. I don’t know So, all that to say, is there anything other than weekly chiro adjustments & muscle relaxants to help patients like me suffering from neck pain that runs from ear to ear along the occiput & down the neck? Is my condition Craniocervical Syndrome?
    P.S. What has seemed to help is daily hydrocollator tx (I bought a small one after it helped so much during P.T.)

  4. Unhinged says:

    I love reading the information on this site! I have Ehlers-Danlos syndrome & am having debilitating cervical spine subluxations for almost a year. Unfortunately, the only doctor I have who is knowledgeable about EDS is the geneticist who diagnosed me. These subluxations are debilitatingly painful, and cause me to scream out loud on agony, and sometimes drop to my knees. I feel an electric JOLT in my skull, as well as a stabbing, pinching, severe stinging in my neck, while simultaneously feeling like I’ve taken a severe blow to my neck with a hard object. It is literally torturing me & has been happening almost daily, now. I have had x-rays that show only some degenerative changes. I’ve seen my primary, my rheumatologist, geneticist (who confirmed that this IS subluxation / dislocation), and a neurologist. (my neuro exam is perfect & i have NO neurological symptoms). Everyone is stumped as to how to help me. Monday, I am having a SUPINE MRI (there is not a single “upright MRI” in all of MA!!!). The BOSTON area has no upright MRI! How can that be? My neurologist is having me imaged by who she says is the “best neuroradiologist in Boston”. However, my suspicion is that I have LAX ligaments in my cervical spine, and I have read that NOTHING will show on a supine MRI. Is that correct? I have had many, frequent dislocations in multiple joints including both shoulders, my jaw, pelvis, SI joints, cuboid bones in my feet. I don’t think any “subluxation” will show on the MRI, if it is not happening at that very moment! How do I get help?


    • Hello Nancy,,
      You are right about upright MRI. Dr. Thomas Milhorat of the Chiari Institute has shown that due to lax ligaments in the upper cervical spine patients with EDS can have cranial settling when they sit or stand upright. Cranial settling causes the skull to sink and slide foward slightly on the upper cervical spine. This decreases the normal upper cervical intervals (spaces) between the skull and upper cervical spine. Flexing the neck forward can further decrease the intervals. Decreasing the upper cervical intervals can result in a kinematic (movement) Chiari 1 type malformations. There are experts in EDS who will help guide you as to lifestyle modifications to help protect and stabilize joints, as well as how to contend with frequent subluxations. If I were treating you my job would be to reset the subluxated joints and help heal the strains associated with them. I would use very gentle non-force techniques such as craniosacral for the spine in conjunction with physiotherapy such as electrical muscle stim to ease pain and inflammation, and friction massage to rehab connective tissues and tendon damage caused by subluxations and dislocations. I would also work with you on developing a special strengthening routines that focus on tendon strength to compenstate for the lax ligamnets.

  5. Unhinged says:

    Thanks so much for the quick reply. Unfortunately, YOU know more about EDS than anyone who has ever treated me. It is BEYOND frustrating to have a condition that I end up having to explain to practioners. Any PTs or Chiros I have seen usually do things that are contraindicated for people with congenital laxity, and I have to discontinue with them so I don’t further damage my joints! I am able to manage most of my pain with medication, but not when it comes to my cervical spine subluxations. They are incapacitating & debilitating. Because there are NO upright MRIs in my area (BOSTON…. The Mecca of medical advancement….ha!), I will have an almost “useless” supine MRI on Monday. The only benefit may be that they will visualize my spinal cord, and hopefully, the subluxations haven’t done any damage. It took me 40 years to finally be diagnosed with Ehlers-danlos syndrome. Now, I have an accurate diagnosis & STILL no adequate treatment. If it weren’t for my psychiatrist who manages my pain, I would have given up by now. I’ll let you know how the MRI goes. Thanks for your great website & your knowledge and compassion.

  6. Pingback: Ehlers-Danlos syndrome | Find Me A Cure

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