THE ASSOCIATION OF CEREBELLAR TONSILLAR HERNIATION WITH BASILAR IMPRESSION INCIDENT TO PAGET'S DISEASE

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Abstract
Two patients with basilar impression due to Paget's disease died suddenly from bulbomedullary compression. This is in contrast with the concept that such neurologic changes are most apt to be slowly progressive. The presence of tonsillar herniation is regarded as contributing to brain stem compression and as augmenting pressure changes affecting the upper spinal cord, the cerebellum and the vascular structures in the vicinity of the foramen magnum and the invaginated base of the skull. In the assessment of basilar impression, it was found that a vertical line drawn from McGregor's line to the most convex portion of the invaginated skull base provided a better index of basilar invagination than measurements which relate the base of the skull to the position of the dens.

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