When we talk about injuries in the head and neck region, it’s natural to focus on the brain itself—after all, a traumatic brain injury (TBI) can have devastating consequences. However, there’s a critically important piece of the puzzle that often goes overlooked: upper cervical spine injuries. These injuries can present with symptoms nearly identical to those of a mild TBI, leading to confusion and sometimes incomplete care.
Below, we explore how a ligamentous injury in the cervical spine can mimic the symptoms of a brain injury and why understanding this distinction is vital for effective diagnosis and treatment.
Despite being separate conditions, the key challenge arises because an upper cervical spine injury can produce symptoms that mirror those of a traumatic brain injury. For instance:
In short, a patient with an upper cervical ligament injury can present with the same set of symptoms you’d expect from a TBI, even though the injury is located in the neck rather than the brain.
A cervical sprain (often referred to clinically as a spinal ligament injury) involves damage to the soft tissues that stabilize the upper cervical vertebrae. Because the upper cervical region (C0–C4) houses critical neural pathways, disruptions here can have far-reaching effects on the body’s balance, coordination, and even cognitive functions.
Proper imaging—such as stress X-rays and CRMA™ (Computerized Radiographic Mensuration Analysis)—can help pinpoint the exact location and severity of ligament damage. Unfortunately, if these tests are not performed or interpreted correctly, the neck injury can go unrecognized, leaving the patient with unresolved symptoms often attributed purely to the “brain injury” label.
Unlike disc injuries (which can be measured by bulges or herniations) or ligament injuries (measured by the degree of excessive motion on stress imaging), brain injuries are trickier to define in terms of visible deformation. Many patients with mild TBIs show relatively normal MRI or CT scans, yet continue to suffer cognitive, behavioral, and sensory symptoms. This diagnostic complexity often means less attention is paid to the possibility of a coexisting cervical injury that could be driving or exacerbating these symptoms.
It’s critical to remember that some injuries—like direct trauma to the eye, ear, or psychological stress—can cause TBI-like symptoms (visual disturbances, balance issues, or cognitive dysfunction) without involving the neck at all. But a ligament injury in the upper cervical spine can cause all of these symptoms, plus more, due to the cervical spine’s close relationship with the brainstem and cranial nerves.
Key takeaway: Cervical instability is what we might call the “senior” condition in the sense that it can generate a wide array of symptoms similar to TBIs, yet it’s less frequently diagnosed or addressed.
An upper cervical spine injury can easily masquerade as a traumatic brain injury, presenting the same functional impairments and quality-of-life challenges. Accurate diagnosis requires specialized imaging and clinical expertise. As more providers become aware of how critical cervical ligament damage can be, they can more effectively help patients who’ve been left with lingering symptoms after a head-and-neck trauma.
By properly evaluating and treating these ligament injuries, healthcare professionals can unlock better outcomes for patients—and help reduce the prevalence of chronic, unresolved symptoms that might otherwise be attributed exclusively to TBI.
If you suspect a patient has a cervical injury compounding their TBI-like symptoms, consider specialized imaging (like CRMA™) and collaboration with spine experts who understand how to stabilize and rehabilitate upper cervical ligament damage. The difference in long-term outcomes can be profound.