CHIARI?????????

Chiari malformation describes a condition in which a portion of the brain herniates, pushing through the opening at the base of the skull. As the herniated tissue pushes through this opening, it presses against the brainstem, blocking the flow of cerebrospinal fluid (CSF). Chiari malformations may be present at birth (congenital). In some patients, the symptoms may not appear until adulthood. Depending on the extent of herniation, these malformations cause a complex of symptoms that vary from mild to severe.
Of the several types of Chiari malformations, Chiari I is the most common. Although it is the mildest form, symptoms can progress, causing severe pain and debilitating deficits. Chiari I malformation may remain undiagnosed until adulthood because symptoms are either absent, delayed, or misdiagnosed.

What are the symptoms?

The symptoms of Chiari I malformation relate to the extent and the area affected by the herniation. Some patients with Chiari I malformation have no symptoms. Other patients are typically affected by pressure-like headaches or pain at the base of the skull or neck. Typical to a headache caused by Chiari I, these symptoms can worsen with physical strain, coughing, or change in position.

Severe head and neck pain

Headaches brought on by coughing, sneezing or straining

Difficulty swallowing

Frequent gagging and choking

Dizziness and vertigo

Balance problems

Muscle weakness

Loss of fine motor skills

Poor hand coordination

Blurred or double vision

Hypersensitivity to bright lights

Nystagmus (involuntary eye movements)

Difficulty in tracking objects

Tinnitus (buzzing or ringing in the ear)

Hearing loss

Vocal cord paralysis

Sleep apnea

The symptoms are complex, progressing over time. Because of this complexity, the condition is often misdiagnosed. At times, Chiari I malformation is mistaken for fibromyalgia, migraine headaches, sinus disease, multiple sclerosis, and other complex disorders of the nervous system. Some patients have waited for years before an accurate diagnosis is made. Accurate diagnosis and plan of treatment is important before the patient’s nervous system suffers permanent injury.