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Diagnosis: Chiari Malformation
Arnold-Chiari malformation is a neurological condition
that
causes compression of the brainstem and the spinal cord at the base of the skull. Symptoms of Chiari
malformation, as it is commonly known, include headache, neck pain, fatigue, swallowing difficulties
and numbness and tingling
of the extremities. It is diagnosed with a special magnetic resonance imaging (MRI) scan.
Chiari, CFIDS
and FM
Some have speculated that Chiari malformations may be responsible for some cases of chronic fatigue and
immune dysfunction syndrome (CFIDS) and fibromyalgia (FM) because of their similar symptoms. Others believe
that some people with Chiari malformations have been misdiagnosed with CFIDS or FM because standard MRI
films only pick up the most obvious Chiari malformations, when lesser degrees of compression might also
cause symptoms. It has not been suggested that Chiari malformation is a cause of CFIDS in general, rather
that
it may contribute to CFIDS symptoms or be misdiagnosed as CFIDS or FM.
Characteristics
Chiari malformation is a structural abnormality in which the
bony area at the base of the skull (the posterior fossa) is too small
to comfortably contain the cerebellum and the spinal cord. Cervical stenosis, a related condition,
involves compression of the upper
spinal column, and can occur alone or in association with a Chiari malformation. In both cases,
important tissues are squeezed, causing pain and impeding the transfer of signals between the brain and
the
body.
Diagnosis
The development
of MRI scans has greatly improved the diagnosis of Chiari malformation, as neurologists and
radiologists can physically see the compression on film. Chiari is readily diagnosed when the cerebellar
tonsils extend
several millimeters below the posterior fossa into the spinal column. Confusion occurs when a patient
with symptoms of Chiari has a
lesser degree of cerebellar herniation. Because some patients with a Chiari malformation on MRI have
no abnormalities on the neurological examination and few symptoms, seeing a Chiari malformation on
the MRI does
not necessarily indicate a need for treatment. Physicians generally obtain an MRI to look for Chiari malformation
only if symptoms and physical findings on the neurological examination are potentially consistent with
this disorder.
Treatment
Surgery to create more space at the
base of the skull and relieve pressure is the standard treatment for Chiari malformation. Techniques
for doing this differ among neurosurgeons and the optimal method for treating Chiari malformation is the
subject of debate.
As with all surgeries, patients should
discuss the pros and cons
carefully with their doctors. This is especially true when considering a form of brain surgery. CFIDS
patients who have undergone decompression surgery have reported
mixed results
, with some experiencing
resolution of many symptoms, others showing little to no improvement and occasional patients reporting
worsening symptoms.
Other resources
From The CFIDS Chronicle:
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