Please let me clarify some issues regarding Chiari I malformation and as it relates to 2 posts (see below)... > Chiari I is a mild birth defect at the base of the skull, > which, in most patients, causes NO problems at all. > Chiari I can be mild but it can also be very significant to symptoms. Read the literature. There are tons of Chiari I articles published in medical journals talking about severe problems and even death in some, usually from respiratory failure....and these are Chiari I, not II or III. Does it really cause no problems at all in most patients with this defect? Well, I wonder. Yes, I've heard that there are asymptomatic people with the Chiari I defect but I suspect this type of statement is not as accurate as it's made out to be. Why? Well, I wonder how many patients are diagnosed with some neurological syndrome (i.e., diagnosis of exclusion based solely on symptomatology) when the doctors don't see a radiological problem and just dismiss an existing Chiari deformity ("don't see" often really means "don't know")? Probably alot and perhaps incorrectly in many. After all, it's not perfectly healthy people who are getting expensive MRI head scans done - it's people with medical problems. If the doctors diagnose a syndrome based solely on symptoms and there is Chiari, perhaps it's the Chiari causing the problems - how can one simply throw out a existing and known disorder as a possible explanation to their problems!? > Be VERY wary of surgeons who want to operate on you for Chiari I > malformation. There is a small group of neurosurgeons who have made > quite a good living by performing these surgeries on people with this > condition. > Fact is that "the small group of neurosurgeons who have made quite a good living by performing these surgeries", as you have put it, have found subtle abnormalities on scans, which are indicators of problems, and these are not yet understood by the vast majority of physicians. Radiological tools are great, but they're far from perfect. So is the field of medicine - doctors say they don't really know what causes many syndromes, but when some docs have made important findings, rather than opening their minds to it, they simply take a cynical view. I guess the world must be flat after all. > Such other conditions as "fibromyalgia" have also been > ascribed to Chiari Type I. There was a program on TV a couple of > years ago which popularized the "cure" and it was so poorly-based > scientifically that the national neurosurgical societies in the USA > published a paper warning the public that surgery for this set of > problems was unproven and not risk-free. > The problem here was the media. The doctors performing this surgery never claimed they had found the cure to Fibromyalgia. The media reported it as such. The doctors have said that there have been people misdiagnosed with Fibromyalgia or Chronic Fatigue Syndrome when they actually have Chiari I and/or cervical spinal stenosis and this is what they are researching. Hmmm, makes one wonder how often this happens with other syndromes too. > Get a good evaluation from a neurosurgical center (such as Dr. > Patrick Kelly at NYU) before you accept this stuff about Chiari Type I. > Chiari I is often problematic. I've been a member of a large Chiari forum for almost 5 years and many patients end up having to travel to see an expert and get relief after years of suffering and being told nonsense such as the posts listed below. In fact, we travelled extensively to see many specialists across North America due to our child's progressive problems. Several neurosurgeons and neuroradiologists told us there was no Chiari I; two experts diagnosed it. We researched it after some nurses mentioned the symptoms sounded like Chiari. We had to travel to the experts and surgery alleviated a ton of symptoms, including respiratory problems, occasional bouts of blindness and many others. It has made all the difference in our child's life. Oh, I forgot to mention - our child had no herniated tonsils - they were at the level of the foramen magnum - that's referred to as 0mm herniation. Most docs think 5mm herniation of the cerebellar tonsils is mild or borderline and nothing to worry about - few think it can be enough to cause problems. Many docs think even larger herniations are mild. Some think it can only cause a very limited number of symptoms or so, such as headaches (wong). Then there are the rest who, for whatever reason, make little effort in learning about Chiari I and cling to the belief that it's not a big deal. The literature says otherwise. Our experience says otherwise, as does that of many others. Our child was misdiagnosed on several occasions and this is very common to Chiari I patients. There is growing acceptance that herniated cerebellar tonsils are only one factor of many to consider when diagnosing symptomatic patients with Chiari I. CSF flow issues and anatomical anomalies in the posterior fossa and cervical spine are critical in making the diagnosis and considering for surgery. We had several neurosurgeons and neuroradiologists tell us our child had no Chiari I and surgery wouldn't help. They were all wrong as my child had such relief from many problems! Once again, this is such a typical scenario in Chiari I patients. There was an article published in the peer-reviewed medical journal called Neurosurgery, May 1999, called "Chiari I malformation redefined". It lists several factors which should be used in the diagnosis of Chiari I. Traditionally, only the amount of herniation of the cerebellar tonsils was used. This belief is slowly changing. As well, the authors state that "symptomatic people with less than 5mm tonsillar herniation should not be excluded from the diagnosis"....referring to the fact that there are other factors to consider in making the diagnosis. The principle author of this publication was the first of only two to diagnose my child with Chiari I. Thank God for this doctor, as well as the other, as it potentially saved my child's life. > Why is surgery being done for Chiari? What are the > symptoms that justify the surgery. There are some people who are > operating on Chiari malformations without good indications (many of > these previously undiagnosed and asymptomatic malformations are > picked up as "incidental findings" on scans). > What criteria/indicators do you use? What symptoms would you consider as possible in symptomatic Chiari I patients? How do you know for sure they are incidental findings? If you see people's head MRIs, it's because they are having neurological problems - which people do you see that are asymptomatic? I wasn't aware that neurosurgeons had a tendency to see perfectly healthy people and their MRI scans - I'm perfectly healthy and have never had a head MRI done - why should I?! Do you often make diagnoses of exclusion without considering these "incidental findings" as possibly significant? There's also been a publication called "Symptomatic tonsillar ectopia" which discusses just that - people with minimal tonsillar herniation (less than 5mm) who've had successful decompression surgery and alleviation of symptoms. There are now publications coming out referring to Chiari 0. These patients are Syringomyelia patients without tonsillar herniation. They benefit from decompression surgery. Syringomyelia is very often associated with Chiari I. One of the reviews of one of these publications by a Chiari expert states that the authors should properly assess the posterior fossa to analyse subtle abnormalities and CSF flow issues (hypoplasia of the occipital bone, steep slope of the tentorium, volumetrically small posterior fossa, CSF flow restriction in the cerebellar cisterns, retroflexion of the odontoid, etc). This simply suggests that these Chiari 0 patients (also referred to as hypoplastic posterior fossa or borderline Chiari I by the experts who know better) may actually have Chiari I. In many, perhaps most, Chiari I patients, a small posterior fossa as a result of an underdeveloped occipital bone simply causes compression such that the cerebellar tonsils are forced into the spinal canal - for whatever reason, this doesn't happen to everyone. In fact, there are other issues being found in Chiari I patients, such as elevated ICP. There are alot of issues with Chiari I and most doctors aren't qualified to make too many comments on it. Chiari I is too often dismissed when it shouldn't be, too often missed and too often misdiagnosed. We Chiari I patients and parents of Chiari I patients know this better than anyone. ACM friends, please feel free to add your comments as some people need to learn the truth about Chiari I malformation....for the benefit of patients and to those reading the inaccurate posts. ES Here are the posts being replied to: http://www.parkinsons-information-exchange-network-online.com/parkmail/msg00132.html http://www.parkinsons-information-exchange-network-online.com/parkmail/msg00134.html ---------------------------------------------------------------------- To sign-off Parkinsn send a message to: mailto:[log in to unmask] In the body of the message put: signoff parkinsn