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Diagnosis of Chiari Malformation

McLaughlin Scrubs SmallBy Mark R. McLaughlin, MD, FACS, FAANS

The symptoms of a Chiari Malformation can be similar to a variety of other conditions. Patients are sometimes told that their chronic headaches and muscle weakness are psychosomatic, or that the symptoms are "all in their head." Because correct diagnosis is critical, Chiari Malformation should be diagnosed and treated only by an experienced neurosurgeon.

The diagnosis process for adult Type 1 Chiari Malformation normally follows this process:

  • Patient experiences Chiari like symptoms
  • Evaluation of neurological signs for possibility of Chiari Malformation
  • MRI evidence of an abnormality
  • Application of the Neurosurgeon's experience and judgement

There is no single, objective test that diagnoses a Chiari Malformation. (i.e. there is no blood test or absolute observable phenomena which defines a Chiari Malformation)

Neurological TestsAdd
A complete neurological exam looks at how the neurological systems of the body are acting, and how those systems respond to different stimuli. The principle parts of a Neurological Exam are:

Cranial Nerves
There are 12 pairs of nerves in your brain which are responsible for function and sensation in your cranial area. These nerves govern smell, taste, swallowing, facial and eye movement, etc.

Coordination and Gait
These tests provide insight into muscle movement, balance, and your overall ability to perform muscular tasks. For example, "gait" is the act of walking. Because gait requires many nerve functions to smoothly work together, it can be an excellent indicator of problems in the nervous system.

Reflexes
This is the testing of your tendon reflexes using a small hammer. Many Chiari patients show an exaggerated response to tests of reflexes.

Motor Function
Fundamentally, your neurosurgeon will examine muscle size, tone, strength, and the softness or rigidity of your muscles. This is done by having the patient resist different types of force.

Sensations
The neurosurgeon tests your ability to perceive different sensations such as touch, vibration, pin pricks, etc.

Spontaneous Venous Pulsations
The veins in the retina of the eye can normally be seen to pulsate when a physician examines your eyes. Where a patient has elevated intracranial pressure, these pulsations tend not to occur, and can be an indicator of elevated intracranial pressure.

MRI
Where the symptoms and neurological exam suggest that Chiari Malformation is suspect, an MRI will be required. The MRI provides an image of the patient’s cranial space, that allows the neurosurgeon to observe abnormal anatomy.

Experience and Judgement
Arguably, the most important part of a diagnosis of Chiari Malformation is the experience and judgment of the neurosurgeon. Treatment of Chiari Malformation must be based on the occurrence and intensity of clinical symptoms rather than simply upon the findings of imaging studies. The advanced imaging available today has led to increased numbers of "incidental diagnosis". For example, this can happen when a patient has an MRI following head trauma. The MRI might show evidence of Chiari Malformation, yet the patient is asymptomatic for Chiari. In such a situation, it is quite unlikely that surgical treatment would be indicated.

If you suspect that you may suffer from Chiari Malformation, or if you exhibit the symptoms described here, we invite you to contact one of our campuses for evaluation and expert treatment.

Dr Mark McLaughlin Chiari Malformation
 

LastUpdate: 2016-07-11 15:41:00

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