Differential diagnoses may include:

• Multiple Sclerosis – due to neurological symptoms, dizziness, and chronic fatigue.
• Brain Tumor – as a possible cause of progressive headaches and neurological dysfunction.
• Cerebellar Tonsillar Ectopia (CTE) – given the presence of occipital headaches, dizziness, and adverse responses to cervical adjusting.
• Chronic Migraine – considering the persistent headaches, visual sensitivity, and nausea.
• Cervicogenic Dizziness – due to neck pain and balance issues.
• Vestibular Dysfunction – as a possible contributor to dizziness and nausea.

Physical Examination Findings

• Neurological Exam:
  • Positive Romberg’s test with balance difficulties.
  • Poor pupillary light response, triggering dizziness.
  • Hyperreflexia in the upper limbs.
• Palpation Findings:
  • Tension and sensitivity in the upper cervical musculature.
  • Dural fascial tension extending into the thoracic spine.
• Orthopedic Exam:
  • Seated Soto Hall test - patient automatically reduces cervical flexion during forward fold, and when instructed to flex neck, complains of exacerbated symptoms.
  • Lumbar flexion measured in Seated Soto Hall test revealed increased ROM with cervical extension and plantar flexion, and decreased ROM with cervical flexion and ankle dorsiflexion. 

• Muscle Testing:
  • Weakness in deltoid muscle with head rotation.
  • All muscles tested scored in the range of 3-4 out of 5 on the Oxford scale (no muscles 5/5).

Question: What diagnostic imaging or tests would you order?