Difficulties in diagnosing Kimerly’s anomaly (own clinical observation)

Abstract

Kimmerle’s anomaly is characterized by the presence of a bony arch of congenital or secondary origin in the structure of the first cervical vertebrae, which restricts the movement of the vertebral artery and causes its compression. This pathology belongs to craniovertebral malformations - congenital anatomical defects of the structure of the junction of the skull with the first cervical vertebra. Kimerly’s anomaly is diagnosed in approximately 12-30% of the population, causing vertebral artery syndrome, which is the cause of chronic ischemia in the posterior parts of the brain. Purpose - to describe the clinical case of Kimmerle’s anomaly in a teenager as an example of a long diagnostic search for this pathology. Clinical case. A 9-year-old girl complained of frequent headaches accompanied by vomiting. Similar conditions occurred every 3-4 weeks. Gastroenterological and neurological factors were not detected. The conditions were relieved by sleep, and drug therapy was not effective. During puberty, such attacks became less frequent and later disappeared. At the age of 16, the girl began to complain of neck pain, recurrent migraines, sharp «shooting» pain in the ear, accompanied by a buzzing sound, ringing, later joined by syncopal states, gait instability, and facial muscle weakness. An X-ray of the craniovertebral junction revealed Kimmerle’s anomaly. The patient’s condition improved with the use of the Shantz collar and constant physical therapy and neuroprotective therapy. Conclusions. Kimmerle’s anomaly can be asymptomatic and incidental, but in younger patients with a combination of neuro-otolaryngological symptoms and drop attacks, this pathology should be excluded. When taking anamnesis, attention should be paid to the chronology and conditions of symptom onset, as well as the patient’s medical history. The research was carried out in accordance with the principles of the Helsinki Declaration. The informed consent of the patient was obtained for conducting the studies. No conflict of interests was declared by the authors.