{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,25]],"date-time":"2026-08-25T02:02:28Z","timestamp":1787623348765,"version":"build-2736575974"},"reference-count":179,"publisher":"MDPI AG","issue":"6","license":[{"start":{"date-parts":[[2026,3,14]],"date-time":"2026-03-14T00:00:00Z","timestamp":1773446400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background: Hypermobile Ehlers\u2013Danlos syndrome (hEDS) can present as a complex interplay of widespread symptomatology and multisystem involvement, posing diagnostic and treatment challenges. Objective characterization of cervical spine and neurovascular findings in hEDS has been limited. Previous studies have emphasized upper cervical spine complications in hEDS, yet the relevance and mechanisms underlying associated symptomatology have not been elucidated. This study examined objective test findings in patients with hEDS at an outpatient neck clinic to explore cervical spine and neurovascular pathology that could contribute to further understanding the clinical profile of a subset of patients with hEDS. Methods: This single-center, retrospective observational study included patients with hEDS aged 20\u201350 years from 1 January 2022\u201331 December 2024, at an outpatient neck center. It excluded previous neck surgery, traumatic events, or related injury. Demographic, clinical, and diagnostic data were collected through a retrospective chart review, including measurements from standard clinical diagnostic protocols: digital motion X-ray (videofluoroscopy), cone beam CT, Doppler ultrasound, and tonometry. Results: More than 71% of patients reported \u226529 symptoms. Nearly all patients exhibited co-occurring forward head, decreased depth of curve, ligamentous cervical instability, and decreased internal jugular vein (IJV) and vagus nerve cross-sectional area (CSA). Vagus nerve CSA was found to be significantly smaller than the comparative healthy\/normal population. IJV CSA was significantly smaller at C1 than at C4\u2013C5, suggesting evidence of carotid sheath compression at C1. Conclusions: This study offers novel evidence that cervical spine pathology, IJV compression, and vagus nerve degeneration are uniformly prevalent in hEDS, which may contribute to, or be an etiological basis for, the multisystem involvement in a subset of patients with this disorder. These findings provide hypothesis-generating data to inform future mechanistic and therapeutic studies, including exploration of new diagnostic and treatment targets.<\/jats:p>","DOI":"10.3390\/jcm15062212","type":"journal-article","created":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T08:41:26Z","timestamp":1773650486000},"page":"2212","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Characterizing Initial Cervical Spine and Neurovascular Findings in 84 Consecutive Patients with Hypermobile Ehlers\u2013Danlos Syndrome: A Retrospective Study"],"prefix":"10.3390","volume":"15","author":[{"given":"Ross A.","family":"Hauser","sequence":"first","affiliation":[{"name":"Caring Medical Florida, 9738 Commerce Center Court, Fort Myers, FL 33908, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan","family":"Griffiths","sequence":"additional","affiliation":[{"name":"Independent Researcher, 9738 Commerce Center Court, Fort Myers, FL 33908, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-6777-2512","authenticated-orcid":false,"given":"Ashley","family":"Watterson","sequence":"additional","affiliation":[{"name":"Division of Behavioral and Organizational Sciences, Claremont Graduate University, 150 East 10th Street, Claremont, CA 91711, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Danielle","family":"Matias","sequence":"additional","affiliation":[{"name":"Caring Medical Florida, 9738 Commerce Center Court, Fort Myers, FL 33908, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5530-1634","authenticated-orcid":false,"given":"Benjamin R.","family":"Rawlings","sequence":"additional","affiliation":[{"name":"Caring Medical Florida, 9738 Commerce Center Court, Fort Myers, FL 33908, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Mart\u00edn-Mart\u00edn, M., Cort\u00e9s-Mart\u00edn, J., Tovar-G\u00e1lvez, M.I., S\u00e1nchez-Garc\u00eda, J.C., D\u00edaz-Rodr\u00edguez, L., and Rodr\u00edguez-Blanque, R. (2022). Ehlers\u2013Danlos Syndrome Type Arthrochalasia: A Systematic Review. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19031870"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e031365","DOI":"10.1136\/bmjopen-2019-031365","article-title":"Diagnosed Prevalence of Ehlers\u2013Danlos Syndrome and Hypermobility Spectrum Disorder in Wales, UK: A National Electronic Cohort Study and Case\u2013Control Comparison","volume":"9","author":"Demmler","year":"2019","journal-title":"BMJ Open"},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"Daylor, V., Griggs, M., Weintraub, A., Byrd, R., Petrucci, T., Huff, M., Byerly, K., Fenner, R., Severance, S., and Griggs, C. (2025). Defining the Chronic Complexities of hEDS and HSD: A Global Survey of Diagnostic Challenges, Life-Long Comorbidities, and Unmet Needs. J. Clin. Med., 14.","DOI":"10.1101\/2025.06.05.25329074"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e53646","DOI":"10.2196\/53646","article-title":"Lack of Diversity in Research on Females with Ehlers\u2013Danlos Syndromes: Recruitment Protocol for a Quantitative Online Survey","volume":"13","author":"Glayzer","year":"2024","journal-title":"JMIR Res. Protoc."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S0929-6646(09)60187-X","article-title":"Clinical Features of Ehlers\u2013Danlos Syndrome","volume":"105","author":"Yen","year":"2006","journal-title":"J. Formos. Med. Assoc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"2981","DOI":"10.1002\/ajmg.a.36293","article-title":"Ehlers\u2013Danlos Syndrome, Hypermobility Type: A Characterization of the Patients\u2019 Lived Experience","volume":"161","author":"Murray","year":"2013","journal-title":"Am. J. Med. Genet. Part A"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1002\/ajmg.a.63426","article-title":"Looking Back and beyond the 2017 Diagnostic Criteria for Hypermobile Ehlers\u2013Danlos Syndrome: A Retrospective Cross-sectional Study from an Italian Reference Center","volume":"194","author":"Ritelli","year":"2024","journal-title":"Am. J. Med. Genet. Part A"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"318","DOI":"10.1002\/dvdy.220","article-title":"Hypermobile Ehlers\u2013Danlos Syndromes: Complex Phenotypes, Challenging Diagnoses, and Poorly Understood Causes","volume":"250","author":"Gensemer","year":"2021","journal-title":"Dev. Dyn."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"555","DOI":"10.1111\/ocr.12907","article-title":"Head Posture and Upper Spine Morphological Deviations in Patients with Hypermobile Ehlers\u2013Danlos Syndrome","volume":"28","author":"Jasemi","year":"2025","journal-title":"Orthod. Craniofac. Res."},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Chalela, S., and Russek, L.N. (2024). Presentation and Physical Therapy Management Using a Neuroplasticity Approach for Patients with Hypermobility-Related Upper Cervical Instability: A Brief Report. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1459115"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e39212","DOI":"10.1097\/MD.0000000000039212","article-title":"The Prevalence of Multisystem Diagnoses among Young Patients with Hypermobile Ehlers\u2013Danlos Syndrome and Hypermobility Spectrum Disorder: A Retrospective Analysis Using a Large Healthcare Claims Database","volume":"103","author":"Kozyra","year":"2024","journal-title":"Medicine"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1693","DOI":"10.1111\/jgh.15927","article-title":"Hypermobile Ehlers\u2013Danlos Syndrome and Disorders of the Gastrointestinal Tract: What the Gastroenterologist Needs to Know","volume":"37","author":"Thwaites","year":"2022","journal-title":"J. Gastroenterol. Hepatol."},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Zeitoun, J.-D., Lef\u00e8vre, J.H., De Parades, V., S\u00e9journ\u00e9, C., Sobhani, I., Coffin, B., and Hamonet, C. (2013). Functional Digestive Symptoms and Quality of Life in Patients with Ehlers\u2013Danlos Syndromes: Results of a National Cohort Study on 134 Patients. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0080321"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1848","DOI":"10.2106\/JBJS.24.01106","article-title":"Orthopaedic Manifestations in Hypermobile Ehlers\u2013Danlos Syndrome","volume":"107","author":"Eichinger","year":"2025","journal-title":"J. Bone Jt. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"20503121251315021","DOI":"10.1177\/20503121251315021","article-title":"The Prevalence of Hypermobile Ehlers\u2013Danlos Syndrome at a Gender-Affirming Primary Care Clinic","volume":"13","author":"Stein","year":"2025","journal-title":"Sage Open Med."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1038\/s41572-020-0194-9","article-title":"The Ehlers\u2013Danlos Syndromes","volume":"6","author":"Malfait","year":"2020","journal-title":"Nat. Rev. Dis. Primer."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1080\/08998280.2020.1805714","article-title":"Systemic Manifestations of Ehlers\u2013Danlos Syndrome","volume":"34","author":"Song","year":"2021","journal-title":"Bayl. Univ. Med. Cent. Proc."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"605","DOI":"10.1097\/JXX.0000000000000900","article-title":"Clinical Trajectory of Hypermobile Ehlers\u2013Danlos Syndrome\/Hypermobility Spectrum Disorders in Older Adults","volume":"35","author":"Anderson","year":"2023","journal-title":"J. Am. Assoc. Nurse Pract."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"2048","DOI":"10.1093\/rheumatology\/kex241","article-title":"The Multisystemic Nature and Natural History of Joint Hypermobility Syndrome and Ehlers\u2013Danlos Syndrome in Children","volume":"56","author":"Grahame","year":"2017","journal-title":"Rheumatology"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1002\/ajmg.c.31538","article-title":"Hypermobile Ehlers\u2013Danlos Syndrome (a.k.a. Ehlers\u2013Danlos Syndrome Type III and Ehlers\u2013Danlos Syndrome Hypermobility Type): Clinical Description and Natural History","volume":"175","author":"Tinkle","year":"2017","journal-title":"Am. J. Med. Genet. Part C Semin. Med. Genet."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1002\/ajmg.c.31430","article-title":"Psychopathological Manifestations of Joint Hypermobility and Joint Hypermobility Syndrome\/Ehlers\u2013Danlos Syndrome, Hypermobility Type: The Link between Connective Tissue and Psychological Distress Revised","volume":"169","author":"Sinibaldi","year":"2015","journal-title":"Am. J. Med. Genet. Part C Semin. Med. Genet."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"254","DOI":"10.1186\/s13023-023-02799-y","article-title":"Psychological Interventions for Individuals with Ehlers\u2013Danlos Syndrome and Hypermobility Spectrum Disorder: A Scoping Review","volume":"18","author":"Song","year":"2023","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_23","doi-asserted-by":"crossref","unstructured":"Pezaro, S., Brock, I., Buckley, M., Callaway, S., Demirdas, S., Hakim, A., Harris, C., High Gross, C., Karanfil, M., and Le Ray, I. (2024). Management of Childbearing with Hypermobile Ehlers\u2013Danlos Syndrome and Hypermobility Spectrum Disorders: A Scoping Review and Expert Co-Creation of Evidence-Based Clinical Guidelines. PLoS ONE, 19.","DOI":"10.1371\/journal.pone.0302401"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"3754","DOI":"10.1002\/ajmg.a.62446","article-title":"Dysautonomia in Hypermobile Ehlers\u2013Danlos Syndrome and Hypermobility Spectrum Disorders Is Associated with Exercise Intolerance and Cardiac Atrophy","volume":"185","author":"Fettig","year":"2021","journal-title":"Am. J. Med. Genet. Part A"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"100111","DOI":"10.1016\/j.ajmo.2025.100111","article-title":"Hypermobile Ehlers\u2013Danlos Syndrome: Cerebrovascular, Autonomic and Neuropathic Features","volume":"14","author":"Novak","year":"2025","journal-title":"Am. J. Med. Open"},{"key":"ref_26","first-page":"100360","article-title":"The Effectiveness of Conservative Interventions on Pain, Function, and Quality of Life in Adults with Hypermobile Ehlers\u2013Danlos Syndrome\/Hypermobility Spectrum Disorders and Shoulder Symptoms: A Systematic Review","volume":"6","author":"Higo","year":"2024","journal-title":"Arch. Rehabil. Res. Clin. Transl."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1589\/jpts.30.847","article-title":"Hypermobile Ehlers\u2013Danlos Syndrome and Rehabilitation: Taking Stock of Evidence Based Medicine: A Systematic Review of the Literature","volume":"30","author":"Corrado","year":"2018","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1186\/s13023-025-03615-5","article-title":"Shaping the Future of Care for Patients with Ehlers\u2013Danlos Syndromes: From Multidisciplinary Management to Precision Medicine","volume":"20","author":"Xu","year":"2025","journal-title":"Orphanet J. Rare Dis."},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Hauser, R.A., Griffiths, M., Matias, D., and Rawlings, B.R. (2025). Cervical Oculopathy: The Cervical Spine Etiology of Visual Symptoms and Eye Diseases\u2014A Hypothesis Exploring Mechanisms Linking the Neck and the Eye. Diagnostics, 15.","DOI":"10.3390\/diagnostics15202650"},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Freeman, M.D., Katz, E.A., Rosa, S.L., Gatterman, B.G., Str\u00f6mmer, E.M.F., and Leith, W.M. (2020). Diagnostic Accuracy of Videofluoroscopy for Symptomatic Cervical Spine Injury Following Whiplash Trauma. Int. J. Env. Res. Public Health, 17.","DOI":"10.3390\/ijerph17051693"},{"key":"ref_31","first-page":"945","article-title":"Measurement of the Atlanto-Dental Interval in the Adult","volume":"84","author":"Hinck","year":"1960","journal-title":"Am. J. Roentgenol. Radium Ther. Nucl. Med."},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Hauser, R.A., Matias, D., and Rawlings, B. (2024). The Ligamentous Cervical Instability Etiology of Human Disease from the Forward Head-Facedown Lifestyle: Emphasis on Obstruction of Fluid Flow into and out of the Brain. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1430390"},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Daffner, R. (2011). Imaging of Vertebral Trauma, Cambridge University Press. [3rd ed.].","DOI":"10.1017\/CBO9780511976285"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/BSD.0000000000001307","article-title":"The Utility of Flexion-Extension Radiographs in Degenerative Cervical Spondylolisthesis","volume":"35","author":"Alvarez","year":"2022","journal-title":"Clin. Spine Surg."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"806","DOI":"10.1148\/74.5.806","article-title":"The Normal Cervical Lordosis","volume":"74","author":"Borden","year":"1960","journal-title":"Radiology"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1055\/s-0041-1723807","article-title":"Relationship of Change in Cervical Curvature after Laminectomy with Lateral Mass Screw Fixation to Spinal Cord Shift and Clinical Efficacy","volume":"83","author":"Hou","year":"2022","journal-title":"J. Neurol. Surg. Cent. Eur. Neurosurg."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1097\/WNP.0000000000000856","article-title":"Sonographic Reference Values of Vagus Nerve: A Systematic Review and Meta-Analysis","volume":"39","author":"Abdelnaby","year":"2022","journal-title":"J. Clin. Neurophysiol."},{"key":"ref_38","doi-asserted-by":"crossref","unstructured":"Trollip, L., Alberto, K., and Makgotloe, A. (2023). Optic Nerve Sheath Diameter: A Cross-Sectional Study of Ultrasonographic Measurement in Healthy Black South African Adults. Life, 13.","DOI":"10.3390\/life13101979"},{"key":"ref_39","unstructured":"Spector, R. (1990). Clinical Methods: The History, Physical, and Laboratory Examinations, Butterworth Publishers. [3rd ed.]."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"e14035","DOI":"10.1111\/psyp.14035","article-title":"Publication Guidelines and Recommendations for Pupillary Measurement in Psychophysiological Studies","volume":"59","author":"Steinhauer","year":"2022","journal-title":"Psychophysiology"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"fcad006","DOI":"10.1093\/braincomms\/fcad006","article-title":"Vagal Cross-Sectional Area Correlates with Parasympathetic Dysfunction in Parkinson\u2019s Disease","volume":"5","author":"Huckemann","year":"2022","journal-title":"Brain Commun."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"e33996","DOI":"10.1097\/MD.0000000000033996","article-title":"Ultrasound of the Normal Vagus Nerve Cross-Sectional Area in the Carotid Sheath","volume":"102","author":"Bedewi","year":"2023","journal-title":"Medicine"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"22","DOI":"10.1016\/j.java.2014.11.002","article-title":"Right Internal Jugular Vein Cross-Sectional Area: Is There an Optimal Level for Cannulation?","volume":"20","author":"Aljure","year":"2015","journal-title":"J. Assoc. Vasc. Access"},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"685","DOI":"10.1053\/j.jvca.2012.10.007","article-title":"Clinical Significance of the Cross-Sectional Area of the Internal Jugular Vein","volume":"27","author":"Yoon","year":"2013","journal-title":"J. Cardiothorac. Vasc. Anesth."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"R197","DOI":"10.1186\/cc8200","article-title":"Estimation of the Diameter and Cross-Sectional Area of the Internal Jugular Veins in Adult Patients","volume":"13","author":"Seguin","year":"2009","journal-title":"Crit. Care"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"84","DOI":"10.1136\/oem.2004.019703","article-title":"Acute Effects of Force and Vibration on Finger Blood Flow","volume":"63","author":"Bovenzi","year":"2006","journal-title":"Occup. Environ. Med."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"104681","DOI":"10.1016\/j.jmbbm.2021.104681","article-title":"Compression of the Vascular Wall to Create a Friction Fit in a Vascular Anastomotic Coupler","volume":"123","author":"Nelson","year":"2021","journal-title":"J. Mech. Behav. Biomed. Mater."},{"key":"ref_48","doi-asserted-by":"crossref","first-page":"e5","DOI":"10.1186\/1749-7221-3-1","article-title":"Acute Nerve Compression and the Compound Muscle Action Potential","volume":"3","author":"Stecker","year":"2014","journal-title":"J. Brachial Plex. Peripher. Nerve Inj."},{"key":"ref_49","unstructured":"National Research Council, Board on Human-Systems Integration, and Steering Committee for the Workshop on Work-Related Musculoskeletal Injuries and The Research Base (1999). Work-Related Musculoskeletal Disorders: Report, Workshop Summary, and Workshop Papers, National Academies Press."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"73","DOI":"10.4330\/wjc.v16.i2.73","article-title":"Seeing beneath the Surface: Harnessing Point-of-Care Ultrasound for Internal Jugular Vein Evaluation","volume":"16","author":"Chayapinun","year":"2024","journal-title":"World J. Cardiol."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"1990","DOI":"10.1038\/s41433-025-03787-1","article-title":"Ocular Manifestations in Ehlers\u2013Danlos Syndrome","volume":"39","author":"Kim","year":"2025","journal-title":"Eye"},{"key":"ref_52","doi-asserted-by":"crossref","unstructured":"Alim-Marvasti, A., Ciocca, M., Kuleindiren, N., Lin, A., Selim, H., and Mahmud, M. (2024). Subjective Brain Fog: A Four-Dimensional Characterization in 25,796 Participants. Front. Hum. Neurosci., 18.","DOI":"10.3389\/fnhum.2024.1409250"},{"key":"ref_53","doi-asserted-by":"crossref","unstructured":"Yoon, J.-H., Park, N.-H., Kang, Y.-E., Ahn, Y.-C., Lee, E.-J., and Son, C.-G. (2023). The Demographic Features of Fatigue in the General Population Worldwide: A Systematic Review and Meta-Analysis. Front. Public Health, 11.","DOI":"10.3389\/fpubh.2023.1192121"},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"497","DOI":"10.1046\/j.1526-4610.1998.3807497.x","article-title":"Prevalence of Frequent Headache in a Population Sample","volume":"38","author":"Scher","year":"1998","journal-title":"Headache J. Head Face Pain"},{"key":"ref_55","unstructured":"(2025, December 17). Centers for Disease Control and Prevention Disability Impacts All of Us Infographic, Available online: https:\/\/www.cdc.gov\/disability-and-health\/articles-documents\/disability-impacts-all-of-us-infographic.html."},{"key":"ref_56","unstructured":"(2025, August 14). Global Burden of Neck Pain in 204 Countries from 1990\u20132019. Available online: https:\/\/www.archivesofmedicalscience.com\/Global-burden-of-neck-pain-in-204-countries-from-1990-2019,170962,0,2.html."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"2902","DOI":"10.1002\/ajmg.a.61873","article-title":"Headaches in Hypermobility Syndromes: A Pain in the Neck?","volume":"182","author":"Malhotra","year":"2020","journal-title":"Am. J. Med. Genet. Part A"},{"key":"ref_58","doi-asserted-by":"crossref","first-page":"387","DOI":"10.1007\/s00401-023-02612-x","article-title":"Vagus Nerve Inflammation Contributes to Dysautonomia in COVID-19","volume":"146","author":"Woo","year":"2023","journal-title":"Acta Neuropathol."},{"key":"ref_59","doi-asserted-by":"crossref","first-page":"4993","DOI":"10.1097\/JS9.0000000000001592","article-title":"Transcutaneous Auricular Vagus Nerve Stimulation as a Novel Therapy Connecting the Central and Peripheral Systems: A Review","volume":"110","author":"Zou","year":"2024","journal-title":"Int. J. Surg."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"105149","DOI":"10.1016\/j.jbspin.2021.105149","article-title":"Vagus Nerve Stimulation in Musculoskeletal Diseases","volume":"88","author":"Courties","year":"2021","journal-title":"Jt. Bone Spine"},{"key":"ref_61","first-page":"e64542","article-title":"A Cross-Sectional Study of Cardiovascular Autonomic Reactivity in Ehlers\u2013Danlos Syndrome","volume":"16","author":"Alauddin","year":"2024","journal-title":"Cureus"},{"key":"ref_62","doi-asserted-by":"crossref","unstructured":"Westerman, M., Kafkas, A., Parry-Jones, A., Strong, S., Retzler, C., and Hallam, G. (2025). Neurobiological and Neuropsychological Disturbance in EDS. Front. Neurol., 16.","DOI":"10.3389\/fneur.2025.1648702"},{"key":"ref_63","doi-asserted-by":"crossref","first-page":"e31","DOI":"10.15420\/aer.2023.20","article-title":"Non-Invasive Vagus Nerve Simulation in Postural Orthostatic Tachycardia Syndrome","volume":"12","author":"Chakraborty","year":"2023","journal-title":"Arrhythmia Electrophysiol. Rev."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"195","DOI":"10.1002\/ajmg.c.31549","article-title":"Neurological and Spinal Manifestations of the Ehlers\u2013Danlos Syndromes","volume":"175","author":"Henderson","year":"2017","journal-title":"Am. J. Med. Genet. C Semin. Med. Genet."},{"key":"ref_65","doi-asserted-by":"crossref","unstructured":"Severance, S., Daylor, V., Petrucci, T., Gensemer, C., Patel, S., and Norris, R.A. (2024). Hypermobile Ehlers\u2013Danlos Syndrome and Spontaneous CSF Leaks: The Connective Tissue Conundrum. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1452409"},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"93","DOI":"10.1016\/j.semarthrit.2013.12.006","article-title":"Dysautonomia and Its Underlying Mechanisms in the Hypermobility Type of Ehlers\u2013Danlos Syndrome","volume":"44","author":"Rombaut","year":"2014","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1007\/s12016-019-08755-8","article-title":"The Relationship Between Hypermobile Ehlers\u2013Danlos Syndrome (hEDS), Postural Orthostatic Tachycardia Syndrome (POTS), and Mast Cell Activation Syndrome (MCAS)","volume":"58","author":"Kucharik","year":"2020","journal-title":"Clin. Rev. Allergy Immunol."},{"key":"ref_68","doi-asserted-by":"crossref","unstructured":"Beighton, P.H., Grahame, R., and Bird, H. (2012). Hypermobility of Joints, Springer-Verlag London Limited.","DOI":"10.1007\/978-1-84882-085-2"},{"key":"ref_69","doi-asserted-by":"crossref","unstructured":"Wang, T.J., Stecco, A., Hakim, A.J., and Schleip, R. (2025). Fascial Pathophysiology in Hypermobility Spectrum Disorders and Hypermobile Ehlers\u2013Danlos Syndrome: A Review of Emerging Evidence. Int. J. Mol. Sci., 26.","DOI":"10.3390\/ijms26125587"},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"2331","DOI":"10.1002\/ajmg.a.40507","article-title":"Spinal Manifestations in 12 Patients with Musculocontractural Ehlers\u2013Danlos Syndrome Caused by CHST14\/D4ST1 Deficiency (mcEDS-CHST14)","volume":"176","author":"Uehara","year":"2018","journal-title":"Am. J. Med. Genet. Part A"},{"key":"ref_71","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s10143-023-02249-0","article-title":"Craniocervical Instability in Patients with Ehlers\u2013Danlos Syndromes: Outcomes Analysis Following Occipito-Cervical Fusion","volume":"47","author":"Henderson","year":"2024","journal-title":"Neurosurg. Rev."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Smith, F.W., and Dworkin, J. (2015). The Craniocervical Syndrome and MRI, Karger.","DOI":"10.1159\/isbn.978-3-318-02697-9"},{"key":"ref_73","doi-asserted-by":"crossref","first-page":"266","DOI":"10.21037\/jss-21-132","article-title":"Upper Cervical Spine Instability Systematic Review: A Bibliometric Analysis of the 100 Most Influential Publications","volume":"8","author":"Michel","year":"2022","journal-title":"J. Spine Surg."},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"326","DOI":"10.2174\/1874325001408010326","article-title":"Chronic Neck Pain: Making the Connection between Capsular Ligament Laxity and Cervical Instability","volume":"8","author":"Steilen","year":"2014","journal-title":"Open Orthop. J."},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"186","DOI":"10.14245\/ns.1938138.069","article-title":"A Review of a New Clinical Entity of \u2018Central Atlantoaxial Instability\u2019: Expanding Horizons of Craniovertebral Junction Surgery","volume":"16","author":"Goel","year":"2019","journal-title":"Neurospine"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Skalski, M., Bell, D., and Sharma, R. (2021). Lateral Atlantodental Instability, Radiopaedia.org.","DOI":"10.53347\/rID-87931"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"85","DOI":"10.11648\/j.ejpm.20150304.11","article-title":"The Biology of Prolotherapy and Its Application in Clinical Cervical Spine Instability and Chronic Neck Pain: A Retrospective Study","volume":"3","author":"Hauser","year":"2015","journal-title":"Eur. J. Prev. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"197","DOI":"10.1055\/s-0034-1376371","article-title":"A Review of the Diagnosis and Treatment of Atlantoaxial Dislocations","volume":"4","author":"Yang","year":"2014","journal-title":"Glob. Spine J."},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1944","DOI":"10.1016\/j.spinee.2022.08.008","article-title":"Craniocervical Instability in Patients with Ehlers\u2013Danlos Syndrome: Controversies in Diagnosis and Management","volume":"22","author":"Mao","year":"2022","journal-title":"Spine J."},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1111\/os.14281","article-title":"Novel MRI Signs in Atlantodental Space Predict Reduction Degree of Atlantoaxial Dislocation","volume":"17","author":"Sheng","year":"2025","journal-title":"Orthop. Surg."},{"key":"ref_81","unstructured":"Lacy, J., Bajaj, J., and Christopher, C. (2023). Gillis Atlantoaxial Instability. StatPearls, StatPearls Publishing."},{"key":"ref_82","doi-asserted-by":"crossref","first-page":"751768","DOI":"10.5402\/2012\/751768","article-title":"Ehlers\u2013Danlos Syndrome, Hypermobility Type: An Underdiagnosed Hereditary Connective Tissue Disorder with Mucocutaneous, Articular, and Systemic Manifestations","volume":"2012","author":"Castori","year":"2012","journal-title":"ISRN Dermatol."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"783","DOI":"10.3171\/2022.6.SPINE211011","article-title":"Spinal Manifestations of Ehlers\u2013Danlos Syndrome: A Scoping Review","volume":"37","author":"Marathe","year":"2022","journal-title":"J. Neurosurg. Spine"},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1067\/mem.2001.114319","article-title":"Defining Radiographic Criteria for Flexion-Extension Studies of the Cervical Spine","volume":"38","author":"Knopp","year":"2001","journal-title":"Ann. Emerg. Med."},{"key":"ref_85","doi-asserted-by":"crossref","unstructured":"Russek, L.N., Block, N.P., Byrne, E., Chalela, S., Chan, C., Comerford, M., Frost, N., Hennessey, S., McCarthy, A., and Nicholson, L.L. (2023). Presentation and Physical Therapy Management of Upper Cervical Instability in Patients with Symptomatic Generalized Joint Hypermobility: International Expert Consensus Recommendations. Front. Med., 9.","DOI":"10.3389\/fmed.2022.1072764"},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"533","DOI":"10.1002\/ajmg.c.31953","article-title":"Respiratory Manifestations in the Ehlers\u2013Danlos Syndromes","volume":"187","author":"Bascom","year":"2021","journal-title":"Am. J. Med. Genet. Part C Semin. Med. Genet."},{"key":"ref_87","first-page":"116","article-title":"Hypermobility, the Ehlers\u2013Danlos Syndromes and Chronic Pain","volume":"35","author":"Syx","year":"2017","journal-title":"Clin. Exp. Rheumatol."},{"key":"ref_88","first-page":"440","article-title":"Differential diagnosis of vertigo in functional cervical vertebrae joint syndromes and vertebrobasilar insufficiency","volume":"30","year":"1982","journal-title":"HNO"},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"385","DOI":"10.12965\/jer.2040612.306","article-title":"Upper Cervical Spine Dysfunction and Dizziness","volume":"16","author":"Sung","year":"2020","journal-title":"J. Exerc. Rehabil."},{"key":"ref_90","doi-asserted-by":"crossref","unstructured":"Alsiri, N., and Palmer, S. (2023). Biomechanical Changes in the Gastrocnemius Medius\u2013Achilles Tendon Complex in People with Hypermobility Spectrum Disorders: A Cross-Sectional Compression Sonoelastography Study. Front. Med., 10.","DOI":"10.3389\/fmed.2023.1062808"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"2517","DOI":"10.4103\/jfmpc.jfmpc_95_20","article-title":"Plausible Impact of Forward Head Posture on Upper Cervical Spine Stability","volume":"9","author":"Chu","year":"2020","journal-title":"J. Fam. Med. Prim. Care"},{"key":"ref_92","first-page":"277","article-title":"Assessment of Stresses in the Cervical Spine Caused by Posture and Position of the Head","volume":"25","author":"Hansraj","year":"2014","journal-title":"Surg. Technol. Int."},{"key":"ref_93","doi-asserted-by":"crossref","first-page":"220","DOI":"10.1080\/00140139.2014.967311","article-title":"Head Flexion Angle While Using a Smartphone","volume":"58","author":"Lee","year":"2015","journal-title":"Ergonomics"},{"key":"ref_94","doi-asserted-by":"crossref","unstructured":"Gensemer, C., Daylor, V., Nix, J., Norris, R.A., and Patel, S. (2024). Co-Occurrence of Tethered Cord Syndrome and Cervical Spine Instability in Hypermobile Ehlers\u2013Danlos Syndrome. Front. Neurol., 15.","DOI":"10.3389\/fneur.2024.1441866"},{"key":"ref_95","doi-asserted-by":"crossref","unstructured":"Katz, E.A., Katz, S.B., and Freeman, M.D. (2023). Non-Surgical Management of Upper Cervical Instability via Improved Cervical Lordosis: A Case Series of Adult Patients. J. Clin. Med., 12.","DOI":"10.3390\/jcm12051797"},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1111\/cns.13148","article-title":"Cervical Spondylotic Internal Jugular Venous Compression Syndrome","volume":"26","author":"Ding","year":"2019","journal-title":"CNS Neurosci. Ther."},{"key":"ref_97","doi-asserted-by":"crossref","unstructured":"Dinc\u0103, V., Ionescu, P., Tudose, R.C., Munteanu, M., Vrapciu, A.D., and Rusu, M.C. (2025). Anatomical Reasons for an Impaired Internal Jugular Flow. Medicina, 61.","DOI":"10.3390\/medicina61091627"},{"key":"ref_98","doi-asserted-by":"crossref","first-page":"111304","DOI":"10.1016\/j.jocn.2025.111304","article-title":"Invasive Surgical Management of Cervical Internal Jugular Venous Compression: A Literature Review","volume":"137","author":"Petersingham","year":"2025","journal-title":"J. Clin. Neurosci."},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Lan, D., Song, S., Jia, M., Wang, M., Jiao, B., Liu, Y., Ding, Y., Ji, X., and Meng, R. (2022). Cerebral Venous-Associated Brain Damage May Lead to Anxiety and Depression. J. Clin. Med., 11.","DOI":"10.3390\/jcm11236927"},{"key":"ref_100","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1111\/cns.12859","article-title":"Understanding jugular venous outflow disturbance","volume":"24","author":"Zhou","year":"2018","journal-title":"CNS Neurosci. Ther."},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Zamboni, P., Menegatti, E., Weinstock-Guttman, B., Dwyer, M.G., Schirda, C.V., Malagoni, A.M., Hojnacki, D., Kennedy, C., Carl, E., and Bergsland, N. (2011). Hypoperfusion of Brain Parenchyma Is Associated with the Severity of Chronic Cerebrospinal Venous Insufficiency in Patients with Multiple Sclerosis: A Cross-Sectional Preliminary Report. BMC Med., 9.","DOI":"10.1186\/1741-7015-9-22"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Beggs, C.B. (2013). Venous Hemodynamics in Neurological Disorders: An Analytical Review with Hydrodynamic Analysis. BMC Med., 11.","DOI":"10.1186\/1741-7015-11-142"},{"key":"ref_103","doi-asserted-by":"crossref","first-page":"179","DOI":"10.1159\/000079939","article-title":"Cerebral Venous Infarction: The Pathophysiological Concept","volume":"18","author":"Schaller","year":"2004","journal-title":"Cerebrovasc. Dis."},{"key":"ref_104","doi-asserted-by":"crossref","unstructured":"Kawalec-Rutkowska, A.M., Czaja, J., Sku\u0142a, M., and Simka, M. (2025). Blood Flow in the Internal Jugular Veins in the Lateral Decubitus Body Position in the Healthy People. J. Clin. Med., 14.","DOI":"10.3390\/jcm14041211"},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"3243","DOI":"10.1007\/s00701-023-05620-8","article-title":"ICP during Head Movement: Significance of the Venous System","volume":"165","author":"Khawari","year":"2023","journal-title":"Acta Neurochir."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"R67","DOI":"10.1186\/cc6897","article-title":"Optic Nerve Sonography in the Diagnostic Evaluation of Adult Brain Injury","volume":"12","author":"Soldatos","year":"2008","journal-title":"Crit. Care"},{"key":"ref_107","doi-asserted-by":"crossref","first-page":"201","DOI":"10.1111\/j.1553-2712.2007.00031.x","article-title":"Correlation of Optic Nerve Sheath Diameter with Direct Measurement of Intracranial Pressure","volume":"15","author":"Kimberly","year":"2008","journal-title":"Acad. Emerg. Med."},{"key":"ref_108","doi-asserted-by":"crossref","first-page":"120853","DOI":"10.1016\/j.jns.2023.120853","article-title":"The Role of Optic Nerve Sheath Ultrasonography in Increased Intracranial Pressure: A Systematic Review and Meta Analysis","volume":"454","author":"Berhanu","year":"2023","journal-title":"J. Neurol. Sci."},{"key":"ref_109","doi-asserted-by":"crossref","first-page":"743","DOI":"10.3171\/2014.10.JNS141197","article-title":"Ultrasonographic Measured Optic Nerve Sheath Diameter as an Accurate and Quick Monitor for Changes in Intracranial Pressure","volume":"123","author":"Maissan","year":"2015","journal-title":"J. Neurosurg."},{"key":"ref_110","doi-asserted-by":"crossref","first-page":"101328","DOI":"10.1016\/j.inat.2021.101328","article-title":"Correlations between Optic Nerve Sheath Diameters Measured Using Computed Tomography and Elevated Intracranial Pressure Levels","volume":"26","author":"Jalayondeja","year":"2021","journal-title":"Interdiscip. Neurosurg."},{"key":"ref_111","doi-asserted-by":"crossref","first-page":"62","DOI":"10.3889\/oamjms.2020.3272","article-title":"Optic Nerve Sheath Diameter Cutoff Point for Detection of Increased Intracranial Pressure in the Emergency Department","volume":"8","author":"Ussahgij","year":"2020","journal-title":"Open Access Maced. J. Med. Sci."},{"key":"ref_112","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/s13089-022-00304-3","article-title":"Ultrasonographic Measurement of the Optic Nerve Sheath Diameter to Detect Intracranial Hypertension: An Observational Study","volume":"15","author":"Yic","year":"2023","journal-title":"Ultrasound J."},{"key":"ref_113","doi-asserted-by":"crossref","first-page":"15910199241270660","DOI":"10.1177\/15910199241270660","article-title":"Idiopathic intracranial hypertension pathogenesis: The jugular hypothesis","volume":"8","author":"Fargen","year":"2024","journal-title":"Interv. Neuroradiol."},{"key":"ref_114","doi-asserted-by":"crossref","first-page":"110882","DOI":"10.1016\/j.jocn.2024.110882","article-title":"Cranial Venous Outflow Insufficiency; Rendered Almost Invisible to Radiological Imaging by Circular Reasoning. Rethinking Normal Craniocervical Venous Anatomy","volume":"130","author":"Higgins","year":"2024","journal-title":"J. Clin. Neurosci."},{"key":"ref_115","unstructured":"(2026, February 24). Doppler Ultrasonography\u2014An Overview|ScienceDirect Topics. Available online: https:\/\/www.sciencedirect.com\/topics\/nursing-and-health-professions\/doppler-ultrasonography."},{"key":"ref_116","doi-asserted-by":"crossref","first-page":"1302","DOI":"10.1002\/jmri.28182","article-title":"Internal Jugular Vein Geometry Under Multiple Inclination Angles with 3D Low-Field MRI in Healthy Volunteers","volume":"56","author":"Kuijer","year":"2022","journal-title":"J. Magn. Reson. Imaging"},{"key":"ref_117","doi-asserted-by":"crossref","unstructured":"Suwaidi, A.S.A., Moustafa, I.M., Kim, M., Oakley, P.A., and Harrison, D.E. (2023). A Comparison of Two Forward Head Posture Corrective Approaches in Elderly with Chronic Non-Specific Neck Pain: A Randomized Controlled Study. J. Clin. Med., 12.","DOI":"10.3390\/jcm12020542"},{"key":"ref_118","doi-asserted-by":"crossref","first-page":"1117","DOI":"10.1589\/jpts.30.1117","article-title":"Alleviation of Chronic Spine Pain and Headaches by Reducing Forward Head Posture and Thoracic Hyperkyphosis: A CBP\u00ae Case Report","volume":"30","author":"Fortner","year":"2018","journal-title":"J. Phys. Ther. Sci."},{"key":"ref_119","doi-asserted-by":"crossref","unstructured":"Moustafa, I.M., Diab, A.A., Hegazy, F., and Harrison, D.E. (2018). Does Improvement towards a Normal Cervical Sagittal Configuration Aid in the Management of Cervical Myofascial Pain Syndrome: A 1- Year Randomized Controlled Trial. BMC Musculoskelet. Disord., 19.","DOI":"10.1186\/s12891-018-2317-y"},{"key":"ref_120","doi-asserted-by":"crossref","unstructured":"Midtlien, J.P., Curry, B.P., Chang, E., Kiritsis, N.R., Aldridge, J.B., and Fargen, K.M. (2024). Characterizing a New Clinical Phenotype: The Co-Existence of Cerebral Venous Outflow and Connective Tissue Disorders. Front. Neurol., 14.","DOI":"10.3389\/fneur.2023.1305972"},{"key":"ref_121","doi-asserted-by":"crossref","unstructured":"Li, M., Sun, Y., Chan, C.C., Fan, C., Ji, X., and Meng, R. (2019). Internal Jugular Vein Stenosis Associated with Elongated Styloid Process: Five Case Reports and Literature Review. BMC Neurol., 19.","DOI":"10.1186\/s12883-019-1344-0"},{"key":"ref_122","doi-asserted-by":"crossref","first-page":"1247","DOI":"10.3174\/ajnr.A2953","article-title":"Incidence of Extrinsic Compression of the Internal Jugular Vein in Unselected Patients Undergoing CT Angiography","volume":"33","author":"Jayaraman","year":"2012","journal-title":"Am. J. Neuroradiol."},{"key":"ref_123","doi-asserted-by":"crossref","first-page":"fcab043","DOI":"10.1093\/braincomms\/fcab043","article-title":"Impaired Glymphatic Function in Idiopathic Intracranial Hypertension","volume":"3","author":"Eide","year":"2021","journal-title":"Brain Commun."},{"key":"ref_124","doi-asserted-by":"crossref","unstructured":"Tu\u021b\u0103, S. (2022). Cerebral Venous Outflow Implications in Idiopathic Intracranial Hypertension\u2014From Physiopathology to Treatment. Life, 12.","DOI":"10.3390\/life12060854"},{"key":"ref_125","doi-asserted-by":"crossref","first-page":"577","DOI":"10.1212\/WNL.0000000000201037","article-title":"Pearls & Oy-Sters: Cerebral Venous Congestion Associated with Cognitive Decline Treated by Jugular Release","volume":"99","author":"Primiani","year":"2022","journal-title":"Neurology"},{"key":"ref_126","doi-asserted-by":"crossref","first-page":"1305","DOI":"10.1002\/acn3.51822","article-title":"Long-term Safety and Efficacy of Stenting on Correcting Internal Jugular Vein and Cerebral Venous Sinus Stenosis","volume":"10","author":"Bai","year":"2023","journal-title":"Ann. Clin. Transl. Neurol."},{"key":"ref_127","doi-asserted-by":"crossref","first-page":"365-e13","DOI":"10.1111\/ene.13512","article-title":"Intracranial Hypertension Induced by Internal Jugular Vein Stenosis Can Be Resolved by Stenting","volume":"25","author":"Zhou","year":"2018","journal-title":"Eur. J. Neurol."},{"key":"ref_128","doi-asserted-by":"crossref","first-page":"554","DOI":"10.1093\/ons\/opz012","article-title":"Styloidogenic Jugular Venous Compression Syndrome: Clinical Features and Case Series","volume":"17","author":"Zhao","year":"2019","journal-title":"Oper. Neurosurg."},{"key":"ref_129","doi-asserted-by":"crossref","first-page":"158","DOI":"10.1055\/s-0036-1594238","article-title":"An Evaluation of Styloidectomy as an Adjunct or Alternative to Jugular Stenting in Idiopathic Intracranial Hypertension and Disturbances of Cranial Venous Outflow","volume":"78","author":"Higgins","year":"2016","journal-title":"J. Neurol. Surg. Part B Skull Base"},{"key":"ref_130","doi-asserted-by":"crossref","first-page":"1997","DOI":"10.1007\/s00701-021-04813-3","article-title":"Lumbar Puncture Position Influences Intracranial Pressure","volume":"163","author":"Pedersen","year":"2021","journal-title":"Acta Neurochir."},{"key":"ref_131","doi-asserted-by":"crossref","first-page":"946","DOI":"10.1136\/bjo.87.8.946","article-title":"Effect of a Tight Necktie on Intraocular Pressure","volume":"87","author":"Teng","year":"2003","journal-title":"Br. J. Ophthalmol."},{"key":"ref_132","doi-asserted-by":"crossref","first-page":"108809","DOI":"10.1016\/j.exer.2021.108809","article-title":"Interplay between Intraocular and Intracranial Pressure Effects on the Optic Nerve Head In Vivo","volume":"213","author":"Zhu","year":"2021","journal-title":"Exp. Eye Res."},{"key":"ref_133","doi-asserted-by":"crossref","unstructured":"Li, Z., Yang, Y., Lu, Y., Liu, D., Xu, E., Jia, J., Yang, D., Zhang, X., Yang, H., and Ma, D. (2012). Intraocular Pressure vs. Intracranial Pressure in Disease Conditions: A Prospective Cohort Study (Beijing iCOP Study). BMC Neurol., 12.","DOI":"10.1186\/1471-2377-12-66"},{"key":"ref_134","doi-asserted-by":"crossref","first-page":"745","DOI":"10.2214\/ajr.176.3.1760745","article-title":"Sonography of the Cervical Vagus Nerve: Normal Appearance and Abnormal Findings","volume":"176","author":"Giovagnorio","year":"2001","journal-title":"AJR Am. J. Roentgenol."},{"key":"ref_135","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1177\/0145561319875432","article-title":"Transcutaneous Sonography for Detection of the Cervical Vagus Nerve","volume":"100","author":"Chen","year":"2021","journal-title":"Ear. Nose. Throat J."},{"key":"ref_136","doi-asserted-by":"crossref","unstructured":"Breit, S., Kupferberg, A., Rogler, G., and Hasler, G. (2018). Vagus Nerve as Modulator of the Brain\u2013Gut Axis in Psychiatric and Inflammatory Disorders. Front. Psychiatry, 9.","DOI":"10.3389\/fpsyt.2018.00044"},{"key":"ref_137","doi-asserted-by":"crossref","unstructured":"Agorastos, A., Mansueto, A.C., Hager, T., Pappi, E., Gardikioti, A., and Stiedl, O. (2023). Heart Rate Variability as a Translational Dynamic Biomarker of Altered Autonomic Function in Health and Psychiatric Disease. Biomedicines, 11.","DOI":"10.3390\/biomedicines11061591"},{"key":"ref_138","doi-asserted-by":"crossref","unstructured":"Van Es, V.A.A., De Lathauwer, I.L.J., Kemps, H.M.C., Handjaras, G., and Betta, M. (2024). Remote Monitoring of Sympathovagal Imbalance During Sleep and Its Implications in Cardiovascular Risk Assessment: A Systematic Review. Bioengineering, 11.","DOI":"10.3390\/bioengineering11101045"},{"key":"ref_139","doi-asserted-by":"crossref","first-page":"458","DOI":"10.1038\/35013070","article-title":"Vagus Nerve Stimulation Attenuates the Systemic Inflammatory Response to Endotoxin","volume":"405","author":"Borovikova","year":"2000","journal-title":"Nature"},{"key":"ref_140","doi-asserted-by":"crossref","first-page":"28","DOI":"10.1016\/j.bbi.2024.11.023","article-title":"The Vagus Nerve: An Old but New Player in Brain\u2013Body Communication","volume":"124","author":"Ma","year":"2025","journal-title":"Brain. Behav. Immun."},{"key":"ref_141","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1038\/nrendo.2012.189","article-title":"The Vagus Nerve and the Inflammatory Reflex\u2014Linking Immunity and Metabolism","volume":"8","author":"Pavlov","year":"2012","journal-title":"Nat. Rev. Endocrinol."},{"key":"ref_142","doi-asserted-by":"crossref","first-page":"e3441","DOI":"10.1002\/brb3.3441","article-title":"Functional Neurological Signs in Hypermobile Ehlers\u2013Danlos Syndrome and Hypermobile Spectrum Disorders with Suspected Neuropathic Pain","volume":"14","author":"Fernandez","year":"2024","journal-title":"Brain Behav."},{"key":"ref_143","doi-asserted-by":"crossref","first-page":"64","DOI":"10.1007\/s40473-014-0010-5","article-title":"Vagus Nerve Stimulation","volume":"1","author":"Howland","year":"2014","journal-title":"Curr. Behav. Neurosci. Rep."},{"key":"ref_144","doi-asserted-by":"crossref","first-page":"2508","DOI":"10.1016\/j.celrep.2019.04.096","article-title":"An Atlas of Vagal Sensory Neurons and Their Molecular Specialization","volume":"27","author":"Kupari","year":"2019","journal-title":"Cell Rep."},{"key":"ref_145","doi-asserted-by":"crossref","unstructured":"Mavroudis, I., Kazis, D., Kamal, F.Z., Gurzu, I.-L., Ciobica, A., P\u0103durariu, M., Novac, B., and Iordache, A. (2024). Understanding Functional Neurological Disorder: Recent Insights and Diagnostic Challenges. Int. J. Mol. Sci., 25.","DOI":"10.3390\/ijms25084470"},{"key":"ref_146","doi-asserted-by":"crossref","first-page":"277","DOI":"10.1016\/j.cgh.2020.02.034","article-title":"Rome IV Functional Gastrointestinal Disorders and Health Impairment in Subjects with Hypermobility Spectrum Disorders or Hypermobile Ehlers\u2013Danlos Syndrome","volume":"19","author":"Lam","year":"2021","journal-title":"Clin. Gastroenterol. Hepatol."},{"key":"ref_147","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1111\/joim.13539","article-title":"Small Fiber Neuropathy in Hypermobile Ehlers Danlos Syndrome\/Hypermobility Spectrum Disorder","volume":"292","author":"Fernandez","year":"2022","journal-title":"J. Intern. Med."},{"key":"ref_148","doi-asserted-by":"crossref","first-page":"155","DOI":"10.1212\/WNL.0000000000002847","article-title":"Small Fiber Neuropathy Is a Common Feature of Ehlers\u2013Danlos Syndromes","volume":"87","author":"Cazzato","year":"2016","journal-title":"Neurology"},{"key":"ref_149","doi-asserted-by":"crossref","first-page":"103306","DOI":"10.1016\/j.autneu.2025.103306","article-title":"Autonomic and Sensory Dysfunction in Hypermobile Ehlers\u2013Danlos Syndrome: How Do Small Fibers Contribute?","volume":"260","author":"Kersebaum","year":"2025","journal-title":"Auton. Neurosci."},{"key":"ref_150","doi-asserted-by":"crossref","first-page":"687","DOI":"10.1002\/ana.21643","article-title":"Neuromuscular Involvement in Various Types of Ehlers\u2013Danlos Syndrome","volume":"65","author":"Voermans","year":"2009","journal-title":"Ann. Neurol."},{"key":"ref_151","doi-asserted-by":"crossref","first-page":"670","DOI":"10.1007\/s00415-005-0056-0","article-title":"Recurrent Neuropathy Associated with Ehlers\u2013Danlos Syndrome","volume":"253","author":"Voermans","year":"2006","journal-title":"J. Neurol."},{"key":"ref_152","doi-asserted-by":"crossref","first-page":"187","DOI":"10.2190\/PM.41.2.g","article-title":"Association between Psychopathological Factors and Joint Hypermobility Syndrome in a Group of Undergraduates from a French University","volume":"41","author":"Vilarrasa","year":"2011","journal-title":"Int. J. Psychiatry Med."},{"key":"ref_153","doi-asserted-by":"crossref","first-page":"508","DOI":"10.1192\/bjp.bp.111.092460","article-title":"Brain Structure and Joint Hypermobility: Relevance to the Expression of Psychiatric Symptoms","volume":"200","author":"Eccles","year":"2012","journal-title":"Br. J. Psychiatry"},{"key":"ref_154","doi-asserted-by":"crossref","first-page":"669","DOI":"10.3171\/jns.1979.51.5.0669","article-title":"Acute Intracranial Hypertension and Auditory Brain-Stem Responses: Part 1: Changes in the Auditory Brain-Stem and Somatosensory Evoked Responses in Intracranial Hypertension in Cats","volume":"51","author":"Nagao","year":"1979","journal-title":"J. Neurosurg."},{"key":"ref_155","doi-asserted-by":"crossref","first-page":"353","DOI":"10.1016\/j.semarthrit.2014.05.013","article-title":"Autonomic Symptom Burden in the Hypermobility Type of Ehlers\u2013Danlos Syndrome: A Comparative Study with Two Other EDS Types, Fibromyalgia, and Healthy Controls","volume":"44","author":"Calders","year":"2014","journal-title":"Semin. Arthritis Rheum."},{"key":"ref_156","doi-asserted-by":"crossref","first-page":"1189","DOI":"10.1016\/j.jacc.2018.12.064","article-title":"Autonomic Nervous System Dysfunction","volume":"73","author":"Goldberger","year":"2019","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_157","doi-asserted-by":"crossref","first-page":"690","DOI":"10.1136\/jnnp.43.8.690","article-title":"Blockage of Axonal Transport Induced by Acute, Graded Compression of the Rabbit Vagus Nerve","volume":"43","author":"Rydevik","year":"1980","journal-title":"J. Neurol. Neurosurg. Psychiatry"},{"key":"ref_158","doi-asserted-by":"crossref","unstructured":"Hauser, R.A., Matias, D., and Rawlings, B.R. (2025). Cervicovagopathy: Ligamentous Cervical Instability and Dysstructure as a Potential Etiology for Vagus Nerve Dysfunction in the Cause of Human Symptoms and Diseases. Front. Neurol., 16.","DOI":"10.3389\/fneur.2025.1572863"},{"key":"ref_159","doi-asserted-by":"crossref","first-page":"23743735251314651","DOI":"10.1177\/23743735251314651","article-title":"The Diagnostic Journey of Dysautonomia Patients: Insights from a Patient-Reported Outcome Study","volume":"12","author":"Walker","year":"2025","journal-title":"J. Patient Exp."},{"key":"ref_160","doi-asserted-by":"crossref","first-page":"105","DOI":"10.1007\/s12026-025-09661-2","article-title":"Dysautonomia: A Common Comorbidity of Systemic Disease","volume":"73","author":"Blitshteyn","year":"2025","journal-title":"Immunol. Res."},{"key":"ref_161","doi-asserted-by":"crossref","unstructured":"Vargas-Caballero, M., Warming, H., Walker, R., Holmes, C., Cruickshank, G., and Patel, B. (2022). Vagus Nerve Stimulation as a Potential Therapy in Early Alzheimer\u2019s Disease: A Review. Front. Hum. Neurosci., 16.","DOI":"10.3389\/fnhum.2022.866434"},{"key":"ref_162","doi-asserted-by":"crossref","unstructured":"Walter, U., Tsiberidou, P., Kersten, M., Storch, A., and L\u00f6hle, M. (2018). Atrophy of the Vagus Nerve in Parkinson\u2019s Disease Revealed by High-Resolution Ultrasonography. Front. Neurol., 9.","DOI":"10.3389\/fneur.2018.00805"},{"key":"ref_163","doi-asserted-by":"crossref","first-page":"1180","DOI":"10.1177\/0333102419833076","article-title":"Vagus Nerve Stimulation for Primary Headache Disorders: An Anatomical Review to Explain a Clinical Phenomenon","volume":"39","author":"Henssen","year":"2019","journal-title":"Cephalalgia"},{"key":"ref_164","doi-asserted-by":"crossref","first-page":"112","DOI":"10.1016\/j.brs.2008.02.001","article-title":"A Pilot Study of Vagus Nerve Stimulation (VNS) for Treatment-Resistant Anxiety Disorders","volume":"1","author":"George","year":"2008","journal-title":"Brain Stimulat."},{"key":"ref_165","doi-asserted-by":"crossref","first-page":"205","DOI":"10.3171\/jns.2003.98.1.0205","article-title":"Quantitative Pupillometry, a New Technology: Normative Data and Preliminary Observations in Patients with Acute Head Injury: Technical Note","volume":"98","author":"Taylor","year":"2003","journal-title":"J. Neurosurg."},{"key":"ref_166","doi-asserted-by":"crossref","first-page":"1611","DOI":"10.4103\/IJO.IJO_953_23","article-title":"Measurement of Dynamic Pupillometry Parameters in Adult Indian Population","volume":"72","author":"Rattan","year":"2024","journal-title":"Indian. J. Ophthalmol."},{"key":"ref_167","doi-asserted-by":"crossref","unstructured":"Wang, Y., Zekveld, A.A., Naylor, G., Ohlenforst, B., Jansma, E.P., Lorens, A., Lunner, T., and Kramer, S.E. (2016). Parasympathetic Nervous System Dysfunction, as Identified by Pupil Light Reflex, and Its Possible Connection to Hearing Impairment. PLoS ONE, 11.","DOI":"10.1371\/journal.pone.0153566"},{"key":"ref_168","doi-asserted-by":"crossref","unstructured":"Szabadi, E. (2018). Functional Organization of the Sympathetic Pathways Controlling the Pupil: Light-Inhibited and Light-Stimulated Pathways. Front. Neurol., 9.","DOI":"10.3389\/fneur.2018.01069"},{"key":"ref_169","doi-asserted-by":"crossref","first-page":"2821","DOI":"10.1007\/s00417-021-05209-w","article-title":"Autonomic Dysfunction Detection by an Automatic Pupillometer as a Non-Invasive Test in Patients Recovered from COVID-19","volume":"259","author":"Karahan","year":"2021","journal-title":"Graefe\u2019s Arch. Clin. Exp. Ophthalmol."},{"key":"ref_170","doi-asserted-by":"crossref","first-page":"1862","DOI":"10.1177\/21925682211068520","article-title":"Craniocervical Instability in Ehlers\u2013Danlos Syndrome\u2014A Systematic Review of Diagnostic and Surgical Treatment Criteria","volume":"12","author":"Lohkamp","year":"2022","journal-title":"Glob. Spine J."},{"key":"ref_171","unstructured":"Russek, L. (2026, February 24). Cervical Instability in Hypermobile Patients: When Orthopedic Problems Cause Neurological Issues. Available online: https:\/\/www.jospt.org\/doi\/10.2519\/jospt.blog.20230917."},{"key":"ref_172","unstructured":"Hackett, G.S., Hemwall, G.A., and Montgomery, G.A. (1993). Ligament and Tendon Relaxation Treated by Prolotherapy, Gustav A. Hemwall. [5th ed.]."},{"key":"ref_173","doi-asserted-by":"crossref","first-page":"CMAMD.S39160","DOI":"10.4137\/CMAMD.S39160","article-title":"A Systematic Review of Dextrose Prolotherapy for Chronic Musculoskeletal Pain","volume":"9","author":"Hauser","year":"2016","journal-title":"Clin. Med. Insights Arthritis Musculoskelet. Disord."},{"key":"ref_174","doi-asserted-by":"crossref","first-page":"701","DOI":"10.3233\/BMR-210097","article-title":"Lumbar Instability as an Etiology of Low Back Pain and Its Treatment by Prolotherapy: A Review","volume":"35","author":"Hauser","year":"2022","journal-title":"J. Back Musculoskelet. Rehabil."},{"key":"ref_175","doi-asserted-by":"crossref","first-page":"301","DOI":"10.26603\/ijspt20200301","article-title":"Past, current and future interventional orthobiologics techniques and how they relate to regenerative rehabilitation: A clinical commentary","volume":"15","author":"Centeno","year":"2020","journal-title":"Int. J. Sports Phys. Ther."},{"key":"ref_176","doi-asserted-by":"crossref","unstructured":"Goh, S.-L., Jaafar, Z., Gan, Y.-N., Choong, A., Kaur, J., Kundakci, B., Abdul Karim, S., Jaffar, M.R., and A Hamid, M.S. (2021). Efficacy of Prolotherapy in Comparison to Other Therapies for Chronic Soft Tissue Injuries: A Systematic Review and Network Meta-Analysis. PLoS ONE, 16.","DOI":"10.1371\/journal.pone.0252204"},{"key":"ref_177","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1093\/bmb\/ldab004","article-title":"Prolotherapy for Chronic Low Back Pain: A Review of Literature","volume":"4","author":"Giordano","year":"2021","journal-title":"Br. Med. Bull."},{"key":"ref_178","first-page":"56","article-title":"Dextrose Prolotherapy for Unresolved Neck Pain","volume":"7","author":"Hauser","year":"2007","journal-title":"Pract. Pain Manag."},{"key":"ref_179","unstructured":"Adam, M.P., Bick, S., Mirzaa, G.M., Pagon, R.A., Wallace, S.E., and Amemiya, A. (1993). Hypermobile Ehlers\u2013Danlos Syndrome. GeneReviews\u00ae, University of Washington."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2212\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,16]],"date-time":"2026-03-16T09:05:41Z","timestamp":1773651941000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/6\/2212"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,14]]},"references-count":179,"journal-issue":{"issue":"6","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["jcm15062212"],"URL":"https:\/\/doi.org\/10.3390\/jcm15062212","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,14]]}}}