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Q. What is the best management option for my Chiari malformation?

Answered by
Dr. Rahul Pramod Patil
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Jun 28, 2022 and last reviewed on: Jun 30, 2022

Hello doctor,

I want your opinion about my Chiari malformation shown and described below. I am a 55-year-old female with a history of single major depressive disorder. I had COVID almost seven months back. I have had headaches, brain fog, memory loss, falling, neck and ear pain, tinnitus, migraine, and nausea since that time. I had an MRI brain with contrast, and the reading showed an 18mm Chiari type 1. Also, I had MRI FLAIR and DWI MRI done. I am meeting my neurologist next week, but I wanted your opinion first. I want surgery to correct this as the migraine medicines do not help, nor do the over-the-counter pain drugs. The radiologist's impression is that I have Chiari 1 malformation; however, no hydrocephalus is seen. Other findings are; that the orbits and mastoid air cells are normal in appearance. In addition, the paranasal sinuses are normal in appearance. A Chiari 1 malformation was seen with the cerebellar tonsils extending about 1.8 cm below the level of the foramen magnum. The cerebellar tonsils have a pointed appearance as they grow inferior to the foramen magnum. There appears to be slight compression of the adjacent cervical medullary junction. However, the fourth ventricle is in a normal position. There is no acute infarct, hemorrhage, midline shift, hydrocephalus, or abnormal enhancing mass. The corpus callosum is normal in appearance—the pituitary gland is unremarkable T1 sagittal images. I had also done CRP and ESR tests last week, with the values being 21.3 and 46, respectively.

I am curretly on Synthroid, Cytomel, Pristiq, vitamin D, B12, and Magnesium for restlessness in the legs.

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Hi,

Welcome to icliniq.com.

I feel sorry for your frequent headache issue, but the good thing is that we have a diagnosis, which is Arnold-Chirari type 1. You need to do a screening magnetic resonance imaging (MRI) of the spine to look for associated findings like syrinx within the cord. Surgery is indicated in your case; this will help you significantly reduce your headache. It would help if you had frequent follow-ups with your neurosurgeon post-operatively.



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