Chiari Malformation

Symptoms of Chiari Malformation

Adults with CM may complain of:

neck pain
balance problems
muscle weakness
numbness or other abnormal feelings in the arms or legs
dizziness
vision problems
difficulty swallowing
ringing or buzzing in the ears
hearing loss
vomiting
insomnia
depression
headache made worse by coughing or straining
hand coordination and fine motor skills may be affected

Symptoms may change for some individuals, depending on the buildup of CSF and resulting pressure on the tissues and nerves. The severity of symptoms and whether CSF fluid is blocked determines if surgery is recommended.

Symptoms in infants with any type of CM may include:

difficulty swallowing
irritability when being fed
excessive drooling
a weak cry
gagging, vomiting or reflux
arm weakness
a stiff neck
breathing problems
developmental delays
inability to gain weight

As an infant, the child may have failure to thrive, gastroesophageal reflux, may not be sitting by six to seven months, or not walking by about 14-15 months. Older children may have headaches, dizziness, ringing in ears, problems with vision. One of the most frequent presentations is scoliosis with infrequent headaches, and no other symptoms.

Diagnosis of Chiari Malformation

Generally, an MRI is the preferred diagnostic test to determine if a cerebellar herniation exists. CT and traditional X-ray is also used, but are not as effective at diagnosing CM.

Treatments for Chiari Malformation

Surgical treatment to correct the compression involves removing a portion of the skull and usually part of the C1 vertebra. At this point the covering of the brain (dura) will likely be opened and a patch of similar material sewn in to make this covering (or dura) larger. The cerebellar tonsils may also be removed. This is done to return the flow of spinal fluid which relieves some or all of the symptoms as pressure is removed from the brain stem. This usually leads to shrinkage of any syrinx (spinal fluid) that might exist. The surgical procedure frequently keeps symptoms from getting worse or coming back.

For adults, some choose to manage their symptoms without surgery until if and when their symptoms become intolerable. Nearly 100% of the time patients who noted headaches as their symptoms improved. It is important to recognize that the size of the herniation of the brain (in millimeters) into the spine is not as important as the symptoms the patient experiences when deciding if surgery is an option.