Looking for opinions on my scan - does everyone think this looks like chiari???
I dont see an image
Hmm, I can see the attachment on my end. ???
I haven't had my appointment yet. I'm actually an MR tech and we found this during a test scan. I've had headaches and neck pain for 2 years.....so this might explain it. I went to a neurologist a year ago and was told my pain was muscle related so I've been ignoring my symptoms. I see the dr. again in about a week.
you definately have some herniation but it looks like there is plenty of fluid there. You also seem to have a slight cervical stenosis at c5 posteriorly and cervical lordosis ... combined they could be altering the CSF flow. I would get a disk of the MR to take to the appointment and have the neurologist look at the parasaggital and coronal slides of the tonsils to check for asymmetry ... check out this lecture entitled "Chiari Malformation: A Name Which Leads to Unnecessary Confusion" at this link. By his standards, you would definately have "Hindbrain Herniation" http://www.csfinfo.org/node/307 good luck
Thank you for your input. What do you mean by "there is plenty of fluid there"? You mean I have herniation but there's no fluid restriction?
You cannot really tell if there is CSF blockage without a cine-flow MRI - the image you have is a T2 mid-saggital image from your run of the mill MRI ... by plenty of fluid, I mean fluid behind the cerebellar tonsil which, as a layman, would make me think that there is some flow but it may be altered because there does appear to be some tonsilar descent which could cause your symptoms (a point of debate by neurologists). Ideally, you would also want to see some more fluid underneath the bottom of your cerebellum as well. However, your cerebellum appears to be resting on the skull base when it should kind of float. Dr. Rekate speaks about the effects of altered flow in the video that I suggested. It is the crux of his arguement for establishing diagnostic criteria for Chiari Malformation. A NS who does not specialize in Chiari probably holds the opinion that if there is flow at all, the herniation, regardless of length, is "incidental" - meaning not the cause of your problems. I personally was told that by the first neurosurgeon that I saw - at Yale. I spent most of the nest year in a dark, quiet room - alone with raging headaches and shooting neck pain (that was year two). He was wrong. Second, your scan does not show markedly "pointed" tonsils. This would be strike two by the mis-diagnosis umpire (the radiologist). Strike three is the fact that the herniation does not extend down to c1 - your first cervical vertebrae. You appear to have a large foramen magnum (hole in the bottom of your skull) which most people with Chiari have (ironically ... since the decompression surgery makes that hole even bigger). Hence, your tonsils are not being disfigured (made pointed) but they may still be disrupting the flow of CSF though not obliterating it. (again, see video) So, a quick glance by a radiologist who does not know much about Chiari might cause him or her to not even measure the descent of the cerebellar tonsils because there is fluid in back of the tonsils, it does not extend to c1, and it does not appear pointed on the mid-saggital image that appears here. Thus, I cannot encourage you enough to get the CD of your scan before your appointment and if there is no mention of herniation on the radiologist report, ask your NL to take a look at it and measure the herniation - especially the views that I mentioned in my last response. I hope that this helps. Good luck!
Sounds like I may have a long road of tests ahead of me?? At this point I'm not sure what should be said to the neurologist. I'm afraid that my symptoms will be overlooked. Does the degree of symptoms depend on the size of the herniation? From what I'm reading, it doesn't necessarily.
Is chiari a condition that will keep progressing? Meaning will the herniation increase if no treatment is taken? I'm aware that each case is unique, but is it more common for symptoms to continue to worsen? My worry is that if I'm having symptoms now, will my condition worsen as time goes on?
The degree of symptoms has no correlation to the length of herniation. There are people with 15mm herniations that were found by accident on an MRI and are symptom free. Conversely, there are folks with minimal herniation who have all the symptoms. The latter is being called by some: Chiari 0. Talking to neurologists can be like like taking to a two year old insofar as they do not listen and they always have to be right. Do you have or have you had a two year old? You have to ask them to listen to you and if they do not, put them in time out. Just kidding - then you find one who will. Ultimately, the diagnosis on Chiari is made based upon symptoms because of what you said: there is no correlation between size of herniation and symptoms.
At the same time, you should probably wait and see what you neurologist has to say. If I am correct, and you do have cervical lordosis and a slight spinal stenosis, that combination can cause headaches and neck pain because of nerve pressure and a whole host of other potential problems. You also appear to have what used to be called "a buffalo hump" just under c5 (I cannot remeber the fancy name). These can often be addressed much less invasively with a combinations of medications, physical therapy, and trigger point injections from a physiatrist. And, any good surgeon would want you to try some combination of these before getting surgery for Chiari anyway. Any sane person should try that before getting Chiari surgery anyway. Again, that is why you want the neurologist to see the scan ... so get the disk before the appointment. All that you have to do is call the place where you had the scan, order a copy, and go pick it up. You paid for it (well your insurance did and you paid for your insurance). Hence, it is your property.
My advice is to look at this road like a marathon rather than a sprint. You have already been dismissed by one boneheaded doctor which makes you a very special member of the group that includes everyone who has had Chiari. There is no quick fix to your chronic pain and neither NSs nor NLs will want you to hop on the operating table immediately even if you have 5mm of tonsilar descent. The good news is that you have a pretty nice looking MRI there. It will be better news if it is read by a decent radiologist and not out-sourced to India. A nice first mile time would be a neurologist who listens to your concerns. If you go on the Chiari Institute (Long Island) website, their intake paperwork has all of the symptoms for Chiari. Print it out, fill it out, and take it to your appointment with the disk of your MRI. The pictures from your MRI and your subjective experience of symptoms should be enough for the neurologist to give the possibility of you having a Chiari Malformation creedence. If the NL doesn't ... then mile two is finding one who will. Most of all, be gentle with yourself. Getting a good neurological diagnosis while potentially being repeatedly dismissed by a bunch of narcicisstic neurologists can be a maddening process. Be patient, be open to many opinions, and the truth will eventually emerge which will, hopefully lead you to some healing. Take care.
I doubt the herniation will incresase but the symptoms, more than llikely, will worsen over time if a Chiari Malformation is the cause of your symptoms. That was my experience. The exception would be if there was something like a tumor or a cyst that enlarged over time and caused your herniation in the first place. That will show up on the MRI ... so you will know that as soon as you see the NL. Many people with Chiari do not become symptomatic until their 40's for some reason ... although the herniation has been present their whole life. Also, chronic pain, in general, is a cyclical pickle. If the cause is not found and properly addressed, it tends to worsen over time - sort of like Hymalayan blackberry bushes. It just keeps growing until you get to the roots and tear them out. Hence, whatever the cause of your pain, it is a good thing that you are searching for a way to alleviate the pain now - right? So rather than worry, focus on the fact that you have the courage to pursue this even though you were already thwarted by one medical professional. o.k.?
That does appear to be a chiari to me