Chiari malformation?

Hi guys,

I’m wondering what you all know about Chiari malformations. I had a MRI of the brain and it shows that I have it, borderline low lying tonsils 1-2mm. Does anyone else know if they do? It’s apparently a common cause of migraines and dizziness/disaqualibrium among other things. The thing is it’s like an MAV diagnosis… controversial. I have a friend who is a PA who works with a neurosurgeon who doesn’t think it is controversial and does the surgery to correct it. I’m trying to decide if i should meet with him. I have been taking Propranolol for almost a month and Zoloft for a little over a week and I can say that my headaches have eased in severity and quantity and my emotional state is a bit better but I still feel like crap and I am losing hope. I am tired of existing I want to live!!

What do you all think? From what I’ve read there is an 80% success rate with the surgery. Would you meet with the doc? Do you think I’m grasping at straws? If surgery is an option would you go for it? How patient should I be with the meds I’m on?

Tammy

I just know from my husband, who is a neurosurgeon that some people actually do have the malformation, but it is VERY rare. He was VERY against me looking into it. My MRI was all clear, though. I convinced him to have someone who does Chiari surgery do these measurements to test for it, and I did not have it. I would just warn to be VERY CAUTIOUS and not jump into anything too quickly.

Regarding treatment, this from Tim Hain at dizziness-and-balance.com:

TREATMENT OF CHIARI MALFORMATION

The literature concerning treatment is large and is almost completely the work of neurosurgeons. There have been several recent review articles concerning indications for surgical treatment (Haroun, Guarnieri et al. 2000, Tubbs and Oakes 2004). There are very few articles concerning conservative management.

The following are the author’s opinions:

  • Surgery
    o Decisions regarding surgery are best based on patient cost/benefit.

    • The cost of brain surgery is substantial - medical risk, monetary cost, and time cost.
    • The main benefit to Chiari surgery is prevention of progression of a condition that is rarely progressive.
    • Chiari surgery is nearly always best avoided in persons who have no neurological findings referable to the posterior fossa.
      o Decisions regarding whether or not surgery is indicated are best made by non-surgeons (i.e. neurologists), as surgeons are often biased towards surgery due to their training, inclination towards active treatments, and other factors.
  • Non-surgical treatment
    o There is no medication that treats the underlying cause of the Chiari malformation (brain displacement downward). There are some medications for neck pain, headache and dizziness that may help with the symptoms.
    o Physical therapy and chiropractic manipulation of the neck does not help the Chiari malformation. In fact, it may make matters worse. We have no objection to massage.
    o Avoidance of activities that precipitates symptoms (such as straining, athletic activity requiring straining or involving forceful movements of the head on shoulders) is often useful. As examples, we would suggest that persons with Chiari malformations not lift heavy weights, or play football.

Who should take care of Chiari malformation patients ?

In our opinion, the Chiari malformation is a condition that should be monitored on a once/year basis by a neurologist, and best of all, by a specialized neurologist – an otoneurologist. The reason for this is that while a neurosurgeon may ultimately operate on a patient with a Chiari, the huge majority of patients do not need brain surgery for the Chiari. We are generally unenthusiastic about asking neurosurgeons to make treatment decisions about elective brain surgery, although there are many instances where this is fine.