Brain-based symptoms reported in young adults evaluated for cervical spine etiology: a retrospective, cross-sectional...

"Brain-based" is a term encompassing physical or psychological symptoms that occur due to altered brain function. Brain-based symptoms are on the rise, commonly associated with factors such as electronic device use, chronic stress, and neuroinflammation, but often with an unknown etiology. Here we explore cervical spine abnormalities as a potential underlying factor.

Based on clinical observations of frequent brain-based complaints, this study aimed to examine whether relatively young adults with brain-based symptoms had patterns of structural cervical spine dysfunction that could explain objective test results and elucidate potential underlying pathophysiologic mechanisms.

Retrospective, cross-sectional: Clinical data were obtained and analyzed from a chart review that identified 227 consecutive patients who reported at least 1-8 brain-based symptoms (brain fog, headaches, difficulty concentrating, anxiety, depression, panic attacks, rumination, and obsessive thoughts) from January 1, 2022 through June 30, 2022. Reported following STROBE guidelines.

Diagnostic imaging revealed 100% of patients to have radiologically identified forward head posture, 90% with decreased depth of cervical lordotic curve, and 87% to have C1-C2 ligamentous cervical instability (LCI). Significantly decreased vagus nerve and internal jugular vein (IJV) cross-sectional areas (CSAs) were found in 95 and 98%, respectively. Elevated optic nerve sheath diameters (ONSDs) were seen in 99% of patients. Internal jugular vein cross-sectional area at C1 was found to be significantly greater when lying on a cervical orthotic compared to lying supine (p < 0.01). Weak but significant relationships were found between C1-C2 ligamentous cervical instability and optic nerve sheath diameter (r = 0.14), and C1-C2 LCI and vagus nerve cross-sectional area (r = -0.15).

Abnormal cervical spine structure, decreased internal jugular vein and vagus nerve cross-sectional areas, and elevated ONSDs were significantly documented in a cohort of patients reporting brain-based symptoms at an outpatient neck center. The documented cervical structural abnormalities and compression of the carotid sheath structures may represent potential contributing factors or etiological basis of some brain-based symptoms in young adults. Further research is warranted to better understand these associations.