And the Answer is. . .Occipitalization and Basilar invagination Both these conditions can lead to a variety of neurologic symptoms, and it is essential for chiropractors to recognize them prior to chiropractic manipulative therapy. Occipitalization is a congenital condition where the C1 vertebral level is either completely or partially fused with the base of the skull (occiput). Primarily the condition will limit cervical range of motion, however other symptoms may include:

• Neck pain and stiffness
• Headaches
• Radicular pain
• Neurologic symptoms secondary to spinal cord or nerve root compression

Basilar invagination is where the odontoid process is abnormally elevated into the foramen magnum, where the brainstem exits the cranial cavity. This may be assessed by using Chamberlain or McRae lines of mensuration. This condition can be either a congenital abnormality (as is likely the case here, given the patients age), however it may also be acquired from bone softening diseases such as rheumatoid arthritis, Paget disease or osteogenesis imperfecta.