Treating Chiari I Malformation
While being evaluated for Chiari malformation (CM-I), it is important to have a thorough neurologic examination. All of some of the following tests may be done during the clinic visit.
1- Cognitive evaluation- asking such questions as the date, place and your full name helps to determine if there is a problem with thinking and memory.
2- Reflexes- Using a small reflex hammer, the areas of the arms, knees, and ankles will be lightly tapped to determine if the reflex are normal and symmetric.
3- Cerebellar function- Because the cerebellum is the area of the brain that controls coordination of movement, tests will be done to determine if this is functioning properly. You may be asked to walk, touch finger to nose, stand with eyes closed and maintain balance, and perform certain movements of the hands and fingers.
4- Cranial nerves- There are nerves within the brain that control a variety of movements and and sensation. Shining a light in each eye determines if the pupils react properly. Hearing, speech, tongue movement, eye movement and facial sensation/movements will also be checked.
5- Sensory evaluation- Sensation is checked using light touch and pinprick (gently with a small sterile pin). This will determine if there are any areas with numbness or decreased sensation.
6- Motor examination- The motor examination tests strength in the face, arms and legs. Walking, standing, sitting, and other muscle movements will be tested.
An MRI (Magnetic Resonance Image) of the brain and/or cervical spine is the test of choice for diagnosis of Chiari malformation (CM-I). An MRI scan creates an anatomical picture of the brain and spinal cord. In CM-I it can show the degree of crowding at the large opening at the bottom of the skull (called the foramen magnum). The MRI can show compression and/or distortion of the cerebellar tonsils, and can also analyze the shape and changes in the bony structures skull and upper cervical spine.
An MRI of the spine can also show the presence of syringomyelia (the collection of abnormal fluid in the spinal cord). Additional information about syringomyelia can be found under the related disorder section. Tethered cord can be diagnosed with an MRI of the lumbar spine (read more under related disorders section).
A CINE flow study is an MRI study that evaluates the flow of spinal fluid through the area of the foramen magnum. The CINE MRI is performed in the MRI scanner- the same as a regular MRI. The test takes about 30 minutes. In some cases, the CINE shows obstruction of flow through the area.
Additional studies may be recommended, such as plain x-rays of the spine to show bone structure, or a 3-dimensional CT scan of the skull.
After the tests have been completed, Dr. Oró will meet with you, and your family to review the imaging studies. The results of the test will be explained and treatment options will be discussed. If one or more of these conditions are present, and if the quality of your life is significantly affected, surgical treatment may be an option. If surgery is an option, the decision to have surgery is made by you. Dr. Oró's goal is to explain the condition, its relation (or lack of relation) to the symptoms, and the nature of the surgery, the possible benefits, and the associated risks.
If surgery is an option, you are encouraged to have all your questions answered, make your decision carefully, and take time in making that decision.
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