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Item The importance of craniovertebral and cervicomedullary angles in cervicogenic headache(2014) Coban, Goken; Coven, Ilker; Cifci, Bilal Egemen; Yildirim, Erkan; Yazici, Ayse Canan; Horasanli, BahriyePURPOSE Many studies have indicated that cervicogenic headache may originate from the cervical structures innervated by the upper cervical spinal nerves. To date, no study has investigated whether narrowing of the craniovertebral angle (CVA) or cervicomedullary angle (CMA) affects the three upper cervical spinal nerves. The aim of this study was to investigate the effect of CVA and/or CMA narrowing on the occurrence of cervicogenic headache. MATERIALS AND METHODS Two hundred and five patients diagnosed with cervicogenic headache were included in the study. The pain scores of patients were determined using a visual analog scale. The nonheadache control group consisted of 40 volunteers. CVA and CMA values were measured on sagittal T2-weighted magnetic resonance imaging (MRI), on two occasions by two radiologists. Angle values and categorized pain scores were compared statistically between the groups. RESULTS Intraobserver and interobserver agreement was over 97% for all measurements. Pain scores increased with decreasing CVA and CMA values. Mean angle values were significantly different among the pain categories (P < 0.001). The pain score was negatively correlated with CMA (Spearman correlation coefficient, r(s), -0.676; P < 0.001) and CVA values (r(s), -0.725; P < 0.001). CONCLUSION CVA or CMA narrowing affects the occurrence of cervicogenic headache. There is an inverse relationship between the angle values and pain scores.Item Traumatic craniocervical junction ligamentous and brain stem injuries and retroclival hematoma: unusual combination of craniocervical junction injuries(2017) Gokdemir, Mahmut; Cifci, Bilal Egemen; Cifci, Gokcen Coban; Duman, Enes; 0000-0002-5676-2747; N-4174-2014Cervical spine injuries are common in pediatric population and usually seen in craniocervical junction due to the anatomical and physiological differences. Combination of rapid hyperextension/hyperflexion traumas due to highspeed motor vehicle accident are known to be the reason of ligamentous injury and retroclival epidural hematoma. Our aim is to describe a rare combination injury of the the apical ligament, retroclival epidural hematoma and the suspicion of brain stem slits, due to rapid hyperextension/hyperflexion and rotational trauma with high-speed motor vehicle accident in a 3 year 8 month old girl. The cervical spine was immobilized with a Philadelphia collar. She is still under treatment in the pediatric intensive care unit with a Glascow Coma Scale of 8 for six months.