A 70-year-old white woman presented to the clinic in December 2016 with constant headache that started in September of the same year.  The pain started in the left occipital area and radiated toward the left temporal area and left eye and was very difficult to lay head down on a pillow to sleep.  She also reported repetitive head and neck movements during the day.

    She also noted feeling unbalanced and unsteady gait for one month which worsened in the last 2-3 weeks.

      On examination, patient complained of headache and pain in the neck on palpation.  Her gait was unsteady, needing stabilization by holding on to husband’s arm and slightly favoring right lower extremity. The neurologic examination findings were otherwise unremarkable.

      Head CT scan was ordered and it showed negative results prior to initial visit. An MRI of the head was ordered to evaluate for ischemic cause or structural abnormality. 

An MRI pattern showing a large pannus posterior to the dens and severely narrowing the spinal canal consistent with pannus.  This diagnosis was later confirmed by physicians at the University of Virginia.