Chiari Malformation

What is it?

Chiari Malformation, also known as Cerebellar Tonsillar Ectopia (CTE) is a condition where the inferior portion of the cerebellum (and sometimes the brain stem) has descended downward into the upper portion of the spinal canal.  This condition creates a ‘choke-point’ in the upper neck, where normal drainage of CSF (cerebrospinal fluid) and blood from the brain is affected.  As the fluid exchange is disrupted and the intracranial pressure increases, it can create a confluence of symptoms for the person suffering from this condition, including headaches, dizziness, and cognitive problems.

Chiari malformation must be diagnosed on MRI imaging, however there is a flaw to the diagnosis as it relates to standard MRI protocol.  Standard MRI is performed with the patient recumbent (lying down).  However, Chiari’s are more accurately diagnosed with the patient upright, so we can evaluate the position of the cerebellar tonsils in gravity.  Without utilizing upright MRI positioning, Chiari malformation will often be not diagnosed in situations where it is in fact present.  It is also potentially misclassified as being less severe than is actually the case.

Chiari malformations are traditionally classified 4 categories, but more recently have been divided into a total of 6 different groups.  Chiari 1 is the most common and is defined as the cerebellar tonsils descended 5mm or more below the foramen magnum (bottom part of skull).  Borderline 1 is when cerebellar tonsils are within 1-4 mm below foramen magnum, and Chiari 0 is when the cerebellar tonsils sit at or within 1 mm below the opening of the skull.  Chiari 0 may or may not have the typical symptoms associated with Chiari malformation.

How is it caused?

Chiari can be caused by a person having a congenital malformed skull or a result of head/neck trauma.  There is also some feeling within the Upper Cervical Chiropractic community that there might be a ‘tethering’ mechanism happening, where the spinal cord dura is being pulled downward as a result of mechanical tension from vertebral misalignment or spinal degeneration/arthritis/disc protrusions.

Implications & Symptoms

The top 11 symptoms of Chiari are:

1. Cognitive issues 2. Numbness/tingling in extremities Throat/Digestive issues like difficulty swallowing 4. Headaches 5. Pain 6. Depression 7. Fatigue 8. Trouble sleeping 9. Weakness in extremities 10. Ear/Vestibular issues like tinnitus, vertigo/dizziness, hearing loss 11. Neck Pain

The chronic pressure imbalance and blockage of CSF drainage from the brain can also cause long-term implications.  CSF carries nutrients from the spinal cord to the brain, and conversely brings waste products away from the brain.  If these waste products are not flushing out of the cranial vault like they are supposed to, it can compromise brain health.  Some researchers theorize that Chiari malformation may be a causative factor in neurodegenerative conditions such as Alzeimer’s, Parkinsons, and Dementia.

Treatment

In some cases, surgical intervention is necessary to remove a portion of the back part of the skull in order to decompress the Cranio-Cervical Junction.  While this often relieves symtoms in the short-term, it does not appear to be very effective in managing symptoms in the long term. Fortunately, there is another option for most patients who fall in the Chiari 0-2 category.

Conservative treatment focuses on creating space in the Cranio-Cervical Junction (where the lower skull meets the upper neck).  This space should serve to remove tension on the spinal cord and allow for healthy drainage of CSF and blood from the brain down into the spinal canal.  This procedure is a specialized form of Chiropractic called Upper Cervical Chiropractic.  Less than 2% of chiropractors specialize in this form of care for complex head & neck conditions, like Chiari malformation.  The doctor utilizes advanced imaging technology and specialized procedures to gently and precisely correct misaligned vertebra in the upper neck (C1 Atlas, and C2 Axis) in order to create more room for the lower cerebellum, brain stem, and upper spinal cord.

At Advance Upper Cervical Chiropractic in Walnut Creek, CA the doctors specialize in complex cases related to the Cranio-Cervical Junction like Chiari Malformation.  They utilize 3D Panoramic imaging and provide gentle, precise corrections to the bones in the upper neck (C1 Atlas, C2 Axis) in order to bring the head/neck alignment into balance.