{"id":15130,"date":"2026-03-20T00:00:53","date_gmt":"2026-03-19T23:00:53","guid":{"rendered":"https:\/\/dev.institutchiaribcn.com\/enfermedades\/brainstem-kinking-or-angulation\/"},"modified":"2026-03-30T12:55:17","modified_gmt":"2026-03-30T10:55:17","slug":"brainstem-kinking-or-angulation","status":"publish","type":"enfermedades","link":"https:\/\/institutchiaribcn.com\/en\/brainstem-kinking-or-angulation\/","title":{"rendered":"Brainstem Kinking or Angulation"},"content":{"rendered":"

Last update: 03\/20\/2026, <\/strong>Dr. Miguel B. Royo Salvador<\/strong><\/a>, Medical Board number 10389.<\/strong> Neurosurgeon y Neurologist.<\/strong><\/p>\n

Definition<\/strong><\/h2>\n

Brainstem Kinking (BSK) or Brainstem Angulation consists in a forward projected angle of the brainstem, formed between the pons and the spinal cord. These structures (pons and medulla) tend to form an angle at the bulbomedullary level. A discrete angulation is found quite frequently on normal imaging studies. A very pronounced angulation is however not frequent.<\/p>\n

It tends to be accompanied by Platybasia, Basilar Invagination and Odontoid retroflexion, especially in very pronounced cases. It is also frequently associated with the Arnold-Chiari Syndrome Type I.<\/p>\n

It is studied as an independent malformation, as it may or may not represent the morphological repercussion on the nervous system of the aforementioned craniocervical malformations.<\/p>\n

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Fig.1.- Sagittal craniocervical MR image with Brainstem Kinking at the level of the pons and the medulla oblongata \u2013 spinal cord. Furthermore, there is Basilar Invagination, Odontoid retroflexion and a descent of the cerebellar tonsils. The increase of the supracerebellar space should be pointed out as it is supporting evidence for the traction theory and contradictory of the theory of a malformation with a small posterior fossa.<\/p>\n

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Symptoms<\/strong><\/h2>\n

Brainstem angulation is diagnosed through imaging (MRI or CT) and is not inherently accompanied by symptoms, unless it manifests together with clinical picture of the other frequently associated skull malformations.<\/p>\n

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Nuclear Magnetic Resonance<\/strong><\/h2>\n

The diagnosis and monitoring of Brainstem Angulation is carried out through imaging, with a Nuclear Magnetic Resonance (NMR), namely a brain or skull NMR (see Fig.1).<\/p>\n

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Causes<\/strong><\/h2>\n

– According to conventional theories:<\/strong><\/p>\n

Brainstem Kinking is associated to several possible congenital causes, for example alpha-dystroglycanopathies.<\/p>\n

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– According to the health method Filum System\u00ae<\/sup>:<\/strong><\/p>\n

According to Dr. Royo-Salvador\u2019s theory, the observed brainstem kinking is due to a congenital mechanism of growth asynchrony between spinal cord and central nervous system and the spine in the embryonic phase. This produces an abnormal cord traction force that is transmitted by the filum terminale from the coccyx up to the skull, spinal cord and brain. The bony skull deformation together with that of the encephalon determine the form and intensity of the nervous tissue angulation. The more important the bony malformations, determined by the traction, are, the more prominent will be the deformation of the kinked brain stem.<\/p>\n

Brainstem Kinking shares the cause of the excessive traction produced by an overly tense Filum Terminale with the Arnold-Chiari Syndrome Type I, idiopathic Syringomyelia and idiopathic Scoliosis, as well as other associated malformations of the craniocervical junction (they are all different manifestations of the Filum Disease).<\/p>\n

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Risk factors<\/strong><\/h2>\n

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The most influential risk factor in the development of Brainstem Kinking is the family history<\/strong>: as a congenital condition, it can be inherited between family members. And it shares genetic incidence with the Filum Disease. The disease mechanism of which can be found in all human embryos, and its translation into clinical manifestations depends on the intensity, context and form of expression of this mechanical conflict.<\/p>\n

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Complications<\/strong><\/h2>\n

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The complications of Brainstem Angulation can depend on the degree of caudal traction and the resulting mechanical conflict in the foramen magnum. The latter conditions the magnitude, intensity or degree of the conflict between the traction of the spinal cord and the brain stem.<\/p>\n

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