Dr. Laura Sheehan has extensively studied the Atlas Orthogonal method in her chiropractic practice. In case studies as well as in her own practice, it has resulted in improvement for patients suffering from Chiari Malformations.
Chiari Malformations (CMs) are structural deficits in your brain’s cerebellum, which controls your balance. CMs may develop when the indented bony space at the lower rear of your skull is smaller than normal, which causes the cerebellum and brain stem to be pushed downward. The resulting pressure may affect functions controlled by this area and block the flow of cerebrospinal fluid (CSF) to and from your brain
The Symptoms of Chiari Malformations
According to ongoing research by the National Institute of Neurological Disorders and Stroke, there are a variety of symptoms of CMs. At Sheehan Chiropractic, I examine patients for Chiari Malformations who are complaining of headaches, neck aches, balance problems, numbness, dizziness, vision problems, muscle weakness, hearing loss, vomiting, insomnia, depression, and other symptoms such as a decline in their motor skills and hand coordination.
A recent vehicle accident or fall can trigger the symptoms of CMs. As with many medical conditions, these symptoms may change from person to person, depending on the amount of buildup of CSF and how much pressure it exerts on the brain tissues and nerves.
Infants may have a variety of symptoms of CMs. These can often include difficulty with swallowing, an irritability while being fed, excessive drooling, gagging, vomiting, arm weakness, stiff necks, an inability to gain weight, developmental delays, and/or a weak cry.
The Causes of Chiari Malformations
Primary or congenital Chiari Malformations can be caused by structural defects in your brain and your spinal cord. These may be the result of genetic mutations or by a lack of proper vitamins and nutrients in your mother’s diet during fetal development.
Primary CM is generally more common than acquired or secondary CM. The latter can be caused later if your spinal fluid is drained excessively from your lumbar or thoracic areas due to an injury, exposure to harmful substances, or infection.
The Classifications of Chiari Malformations
The five types of CMs classifications include:
- Type 1 involves the extension of the lower part of the cerebellum (the cerebellar tonsils) into your foramen magnum, which does not involve the brain stem. Typically, the spinal cord passes through this opening. Type 1 is the most common form of CM. It is typically first noticed during adolescence or childhood. It is also often accidentally noticed while examining a patient for another medical condition. It may not cause symptoms and it can be acquired.
- Type 2 is also known as classic CM and involves the extension of both cerebellar and brain stem tissues into the foramen magnum. The nerve tissue that connects the two halves of the cerebellum (the cerebellar vermis) may sometimes only be partially complete or absent. In many cases, Type 2 is usually accompanied by a myelomeningocele, a form of spina bifida that occurs when your spinal canal and backbone don’t close properly before birth. This can causes a protrusion through a sac-like opening in your back and result in a partial or complete paralysis. The Arnold-Chari malformation is typical to Type 2.
- Type 3 is the most serious form of Chiari Malformations and can typically cause severe neurological defects when your cerebellum and brain steam protrude, or herniate, through the foramen magnum and into your spinal cord. Other Type 3 malformations are caused when the brain’s fourth ventricle protrudes into the spinal cord and circulates cerebrospinal fluid (CSF). In rare instances, the herniated cerebellum tissue can enter a pouch-like structure protruding out of the back of your skull, or when the covering of the brain or spinal cord protrudes through an abnormal opening in your back or skull.
- Type 4 CMs involves an incomplete or underdeveloped cerebellum, called hypoplasia. This rare form of Chiari Malformation occurs where the cerebellar tonsils are in their normal position, but parts of the cerebellum are missing, causing portions of your skull or spinal cord to be visible.
- Type 0 is under debate by some scientists who doubt its validity. It’s caused when headaches and other symptoms are present, but without a protrusion of the cerebellum through the foramen magnum.
The Other Conditions Associated With Chiari Malformations
Individuals who are affected by a CM typically have these related conditions:
- Hydrocephalus is an excessive buildup of CSF in your brain. A CM can block the normal flow of this fluid, resulting in pressure within the head that can cause mental defects and/or an enlarged or misshapen skull. If left untreated, severe hydrocephalus can be fatal. This disorder can occur with any type of CM, but is most commonly associated with Type 2.
- Spina bifida is the incomplete development of your spinal cord and/or its protective covering. The bones around the spinal cord don’t form properly, leaving part of the cord exposed and resulting in partial or complete paralysis. Individuals with Type 2 CM usually have a myelomeningocele, a form of spina bifida in which the bones in the back and lower spine don’t form properly and extend out of the back in a sac-like opening.
- Syringomyelia, or hydromyelia, is a disorder in which a CSF-filled tubular cyst (a syrinx), forms within your spinal cord’s central canal. The growing syrinx destroys the center of your spinal cord, resulting in pain, weakness, and stiffness in your back, shoulders, arms, or legs. Other symptoms of syringomyelia may include headaches and a loss of your ability to feel extremes of hot or cold, especially in your hands, with some people also having severe arm and neck pain.
- Tethered cord syndrome occurs when your spinal cord attaches itself to your bony spine. This progressive disorder can cause abnormal stretching of your spinal cord and can result in permanent damage to your lower body’s and legs’ muscles and nerves. Children with a myelomeningocele have an increased risk of developing a tethered cord later in their life.
- Spinal curvature is common among people with syringomyelia or with CM Type I. Two types of spinal curvature can occur in conjunction with CMs: scoliosis, a bending of the spine to your left or right; and kyphosis, a forward bending of your spine. Spinal curvature is seen most often in children with CM when their skeleton has not yet fully matured.
- Other CMs can also be associated with certain hereditary syndromes that affect neurological and skeletal abnormalities, or other disorders that can affect bone formation and growth, fusion of segments of your bones in the neck, and extra folds in the brain.
The Common Occurrence Of Chiari Malformations
At one time, it was estimated that the condition of CMs occurred in about one in every 1,000 births. However, the increased use and advancements of diagnostic imaging has shown that CM may be much more common today.
Complicating these facts are the realization that some children born with Chiari Malformations may not exhibit symptoms until adolescence or adulthood, if they show them at all. CMs occur more often in women than in men. Also, Type 2 malformations are more prevalent in certain groups, including people of Celtic descent.
The Diagnosis of Chiari Malformations
As stated above, many people who have CMs have not exhibited symptoms. In fact, their malformations are typically discovered during the course of diagnosis or treatment for another disorder. To determine if you have CMs, your doctor will perform a physical exam and check the person’s memory, cognition, balance (a function controlled by the cerebellum), touch, reflexes, sensation, and motor skills (functions controlled by the spinal cord).
Your physician may also order one of the following diagnostic tests:
- An X-ray is a safe, painless procedure taken in your doctor’s office and only take a few minutes. An image of your head and neck cannot reveal a CM, but it can identify bone abnormalities often associated with CMs.
- Computed tomography (a CT scan) that takes about 3 to 5 minutes uses X-rays and a computer to produce two-dimensional pictures of bone and vascular irregularities, certain brain tumors and cysts, brain damage from head injury, and other disorders. This painless, noninvasive procedure can identify hydrocephalus and bone abnormalities associated with CM.
- Magnetic resonance imaging(MRI) is the imaging procedure most often used to diagnose a Chiari Malformation. Like CT, an MRI is painless, noninvasive and performed at an imaging center or hospital. An MRI uses radio waves and a powerful magnetic field to produce a detailed three-dimensional picture or a two-dimensional “slice” of body structures, including your tissues, organs, bones, and nerves. Depending on the part(s) of the body to be scanned, an MRI can take up to an hour to complete.
The Treatment of Chiari Malfunctions (CMs)
While some CMs are asymptomatic and do not interfere with your daily activities, other CMs may require medications to ease your pain and some symptoms.
To correct functional disturbances or stop the progression of damage to the central nervous system, surgery may be the only option. Most individuals who have surgery for CMs do see a reduction in their symptoms and/or prolonged periods of relative stability. However, more than one surgery may be needed to treat your CM.
To create more space for the cerebellum and to relieve pressure on the spinal column, your surgeon may perform posterior fossa decompression surgery on adults with CM. To correct the irregular bony structure, this surgery typically requires making an incision at the back of your skull and removing a small portion of the base of your skull (and sometimes part of your spinal column). Or your neurosurgeon may use a procedure called electrocautery to shrink the cerebellar tonsils, which involves destroying tissue with high-frequency electrical currents.
A spinal laminectomy, a related surgical procedure, involves the removal of part of the arched, bony roof of your spinal canal (the lamina) to relieve pressure on your spinal cord and nerve roots.
In addition, your surgeon may make an incision in the dura (the covering of your brain) to examine your brain and spinal cord, then additional tissue may be added to create more space in your dura to compensate for the flow of CSF.
If you have an infant or a child with myelomeningocele, they may require surgery to reposition the spinal cord and close the opening in their back.
Furthermore, hydrocephalus may be treated with a shunt system to drain excess fluid and relieve pressure inside your head. A sturdy tube is surgically inserted into your head and connected to a flexible tube placed under your skin, to drain excess fluid into either your chest wall or abdomen and can be absorbed by the body. An alternative surgical treatment to relieve hydrocephalus is a third ventriculostomy, which improves the flow of CSF. Here, a small perforation is made in the floor of the third ventricle and your CSF is diverted into the subarachnoid space to relieve pressure.
Finally, surgeons may open the spinal cord and insert a shunt to drain a syringomyelia or hydromyelia, inserting a small tube or catheter into your syrinx for continued drainage.
The Chiari Malformation Research Being Done
Within the U.S. government, the National Institute of Neurological Disorders and Stroke (NINDS), a component of the National Institutes of Health (NIH), supports and conducts research on brain and nervous system disorders, including Chiari Malformations. The NINDS conducts research in its NIH laboratories in Bethesda, Maryland. It supports research through grants to major medical research institutions across the country.
Want More Information?
For further information on neurological disorders or research programs funded by the National Institute of Neurological Disorders and Stroke, please contact the Institute’s Brain Resources and Information Network (BRAIN) at:
P.O. Box 5801
Bethesda, MD 20824
(800) 352-9424
http://www.ninds.nih.gov
A Testimonial From Another Chiropractor
“I had a patient with Arnold Chiari Malformation who had pretty severe symptoms after a car accident. I sent him to Dr. Sheehan for the Atlas Orthogonal work and he did very well! His symptoms really decreased. Thank you Dr. Sheehan! “
– Dr. David Hoewisch, Santa Clara, CA