Kimmerle's anomaly (or ponticulus posticus) as a causative factor of chronic tension headaches and neurosensory hearing loss
KOUTSOURAKI E., AVDELIDI E., KAPSALI S.E., BALOYANNIS S.J.

The ponticles are commonly encountered radiographic anomalies characterized by osseous bridging of the posterior margin of the superior articular facet and the posterior arch of the atlas. They are present to a variable degree in about 35% of dissections and a complete osseous ring enclosing the vertebral arteries is identifiable in up to 15% of cases. The ponticles have been considered a significant factor in transient vertebro-basilar insufficiency, Barre-Lieou syndrome and chronic upper cervical syndrome.

Kimmerle anomaly (also known as ponticulus posticus and foramen arcuale) is an anatomical variant of the first cervical vertebra consisting in the presence of an osseous canal in the place of a sulcus for the vertebral artery. According to the literature, headaches were reported by 83.3% of patients with Kimmerle anomaly. The total number of 50% of Kimmerle patients appeared to suffer from tension-type headaches and nearly 25.6% had headaches of a neurovascular nature. Neuralgic headaches were reported by 24.4% of patients. In 72.2% of patients headaches occurred for the first time before the age of 40 years. The headaches lasted from a few minutes to several days, most frequently from several minutes (43.3% of cases) to a few hours (31.1% of cases). Frequency of headaches in a year was high. Headaches were accompanied by other complaints like dizziness and vertigo, nausea, drop attacks, paresthesia, sight and hearing disturbances and also vegetative symptoms. In cases without pain the most frequent signs were short periods of loss of consciousness, dizziness, and also nausea and dizziness.

We present the case of a18 year old female patient, suffering, since the age of 14, from tension-type headaches and left hearing loss. The headaches lasted from 12 hours to a couple of days; the frequency of the headaches was 2-4 per month; there were no accompanied symptoms except the permanent hearing disturbances in the left side. Brain and Cervical X-ray, CT-scan and MRI revealed Kimmerle's anomaly and audiogram was indicative of neurosensory hearing loss. We think that there is significant correlation of Kimmerle anomaly with headaches and hearing disturbances, causing atlanto-occipital alterations and vertebro-basilar insufficiency. Encephalos 2010, 47(3):150-152.

Key words: Kimmerle's anomaly, chronic tension headache, neurosensory hearing loss.