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Date sent: Sun, 11 Feb 2001 09:15:11 -0500 Send reply to: Parkinson's Information Exchange Network <[log in to unmask]> From: E S <[log in to unmask]> Subject: Chiari malformation and PD? To: [log in to unmask] > Therefore, people who have little or no herniation of the cerebellar > tonsils on MRI are told the scans are normal. In fact, there are now > many people with Fibromyalgia and Chronic Fatigue Syndrome being > diagnosed with Chiari (as well as cervical spinal stenosis) because of > the new findings. Who's to say other CNS disorders are not candidates? > > The main problem is that there are very few docs who know to properly > diagnose it when there is no tonsillar herniation - as I said, this is > the sole criteria that has been used for the diagnosis of Chiari - the > few "experts" know that this is only one criteria and is not even > required. > The current "popularity" of surgery for Chiari malformation is highly controversial. Most mainstream neurosurgical authorities believe (including me) that it is an unproven and perhaps even pecuniary approach (lots of money for doing the operation, which is a serious one). "Fibromyalgia" and "Chronic Fatigue Syndrome" are not recognized as true "diseases" by many, and an association with Chiari malformations is highly suspect. The incidence of Chiari malformation (especially Type I which is the least severe) has increased significantly over the last 15 years or so. This is due to one factor and one factor only; and that is the use of MRI to diagnose other conditions (such as brain tumors, and cervical spine disease). The finding of Chiari I malformation is almost always an incidental finding and usually is of no clinical significance. Significant Chiari malformation (requiring surgery) has, as its symptom complex, a combination of intermittent (often postural) headache, cerebellar dysfunction (balance and coordination problems; *not* tremor or rigidity); motor weakness in the upper extremities; abnormalities in eye movements; and hydrocephalus (obstruction of the spinal fluid). The operations done for true, symptomatic Chiari malformations include posterior fossa craniotomy and decompression of the skull and upper cervical spine; release of any "tethering" which may exist involving the spinal cord, draining of any cysts (called "syringomyelia") in the spinal cord, many of which can extend all the way down the spine into the low back; and, when hydrocephalus is present, a shunt is often necessary. True Chiari malformation is a life-threatening problem. Surgery for Chiari under these conditions carries a significant mortality. Caveat emptor. Best, Bob Robert A. Fink, M. D. 2500 Milvia Street Suite 222 Berkeley, California 94704-2636 USA 510-849-2555 PLEASE NOTE: Because of the takeover of IBMNET by AT&T, my new e-mail address, effective immediately, is: <[log in to unmask]> The old <ibm.net> address will no longer function after March 1, 2001. PLEASE CHANGE YOUR ADDRESS BOOKS.