Barre lieou
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Editor-In-Chief: Robert G. Schwartz, M.D. [1], Piedmont Physical Medicine and Rehabilitation, P.A.
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Overview
The "Posterior Cervical Sympathetic Syndrome of Barre-Lieou consists of headache, neck pain, blurred vision, tinnitus, dysphagia and paresthesias. It felt to be due to a traction injury of the posterior cervical sympathetic chain in association with musculoskeletal injury of the head or neck.
History and nomenclature
In 1925 Jean Alexandre Barre, M.D., a French Neurologist described a syndrome consisting cervicogenic headache in association with ringing in the ears, blurred vision, trouble swalowing and vertigo. The majority of these symptoms were thought to be due to over activity in the posterior cervical sympathetic nervous system (a group of nerves located near the vertebrae in the neck).
The syndrome was again described in 1928 by Yong-Choen Lieou, a Chinese physician. In 1947 Louis Gayral published "Oto-neuro-opthalomologic Manifestations of Cervical Origin" in The Lancet. The article was subtitled the "Posterior Cervical Sympathetic Syndrome of Barre-Lieou" and the name Barre-lieou for the syndrome has been popularized ever since.
Pathophysiology
The Posterior Cervical Sympathetic chain is an extension of the proximal sympathetic chain in the neck. While many mechanisms of injury to the neck have been described, traumatic flexion-extension movment is a common source of Barre-Lieou. Essentially anything that can cause disease or injury to the head and neck can be a perpetrator, however. Other examples include gunshot wounds, infection and immuno-inflammatory disorders.
Symptoms
The identifying factors that distinguish Barre-Lieou from other injuries of the head and neck include involvement of the autonomic nervous system. The most commony described symptoms include tinnitus, vertigo (dizziness, nausea, vomiting, blurred vision, tearing of the eyes and sinus congestion however other symptoms may also include swelling on one side of the face, localized cyanosis (bluish color) of the face, facial numbness, hoarseness, shoulder pain, dysesthesias (pins and needles sensations) of the hands & forearms, muscle weakness and fatigue.
Diagnosis
Sympathetic Skin Response studies (Thermography) are an excellent diagnostic tool for Barre- Lieou [3]. Sympathetic Skin Response studies are a fractal measurement of galvonic impedance. Since both vasomotor and sudomotor physiology is controlled by the autonomic nervous system, assymetry patterns (reduced galvonic impedance or cold regions) in facial structures, especially when seen in association with localized hot spots in the ipsilateral omohyoid or nuchal ligament.