Dr. Ambekar Sudheer
Neurosurgery
The following is an actual conversation between an iCliniq user and a doctor that has been reviewed and published as a Premium Q&A.
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Patient's Query
Hi doctor,
I had an MRI (Magnetic Resonance Imaging) three weeks ago and they told there is Chiari malformation about 8 mm. I went to a neurologist but he did not listen to me. I have a constant headache, a pressure in my necks and shoulders, nausea with vomiting daily. I have a problem with swallowing, buzzing in the left ear. I have been going for pain management for the past two years with numerous injections. Currently, I am taking tablet Percoset 7.5 mg, Tizanidine 12 mg. I have dizziness, my hands, and arms tingle and there is numbness.
Hi, Welcome to icliniq.com.
Tonsillar herniation of more than 5 mm in adults is significant and defined as Chiari type 1 malformation. The usual symptoms associated with this condition are imbalance while walking, cough induced headache, numbness over hands, nape of neck and weakness of hands. Many people are not symptomatic. In asymptomatic people with tonsillar descent more than 5 mm, we usually do CSF (Cerebrospinal Fluid) flow studiesto look at the CSF circulation in the foramen magnum. If the CSF flow is altered, we recommend surgery. If the flow is normal, we observe the patient with periodic clinical exams and imaging. In the images that you have provided (attachment removed to protect patient identity) none of them shows the tonsils. So, I am not able to comment on whether there is Chiari malformation or not.
Patient's Query
Thank you doctor,
I do not understand why the X-ray technician has given tonsils are protruding 8 mm in the report. I have constant headaches daily with neck pain and pressure in my neck and shoulders. I get dizzy very easy and basically have no quality of life.
Hi, Welcome back to icliniq.com.
In case if you have headaches and dizziness, I suggest doing an MRI (Magnetic resonance imaging) with CSF (Cerebrospinal Fluid) flow study around the foramen magnum. If the flow study shows abnormal CSF circulation, you might need surgery. If the CSF circulation is normal, we will have to keep you on follow-up. Surgery for Chiari malformation is usually straightforward and safe. We remove a portion of the bone at the base of the skull to give more space to the tonsils so that they do not compress the critical structures of the brain.
Patient's Query
Thank you doctor,
The tightness and pressure in my neck and the shoulders are almost unbearable. How can I get that type of MRI (Magnetic Resonance Imaging)? Do I need to ask my regular doctor to request it? I have been seeing a doctor for pain management for the past two years and I feel like it is just getting worse.
Hi, Welcome back to icliniq.com.
I suggest you consult a Neurosurgeon for this problem. A pain management specialist is not exactly the best person to deal with Chiari malformation. The neurosurgeon is able to examine you clinically and if needed, the doctor will suggest you, MRI with CSF flow study. For the pain, you may take over-the-counter pain medications such as Tylenol (Acetaminophen) or Advil (Ibuprofen).
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Neurosurgery
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