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Arnold-Chiari Malformation, nails are falling off, controlled by injections. Suggest medical tests.

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My fingers nails are falling off.
I suffer from Arnold-Chiari Malformation Type 1 and low B12, however this is controlled by injections and is now at an average/ above average level. What could be the cause and what medical tests should be carried out?
Mon, 21 May 2012 in Brain and Spine
Answered by Dr. Naveen Kumar 2 hours later

Thanks for the query

‘Arnold Chiari Malformation’ is a malformation of the brain wherein the Cerebellum - a part of the brain gets invaginated into the defects in the lower part of the skull. Because of this herniation there is obstruction to the flow of the CSF flow in the brain causing hydrocephalus (build-up of fluid inside the skull, leading to brain swelling). There are 4 grades (I-IV) in this condition of which the Grade IV is the most severe one.

Grade I is the mild variety of this condition which does not produce any symptoms and is detected accidentally. This is usually seen in the childhood but goes unnoticed. It could be due to structural defects in the brain and spinal cord that occur during fetal development. Also, thought to be caused by genetic mutations or lack of proper vitamins or nutrients in the maternal diet during pregnancy.

Grade I does not cause any serious neurological problem, hence regular follow-up with an MRI would suffice. Medications will reduce symptoms, such as pain, but surgery may be required to correct functional disturbances or halt the progression of damage to the central nervous system.

Hope I have answered your query, if you have any more doubts you are welcome.

Dr. Naveen Kumar
Above answer was peer-reviewed by
Follow-up: Arnold-Chiari Malformation, nails are falling off, controlled by injections. Suggest medical tests. 42 minutes later
I understand what Chiari is and am currently awaiting surgery to correct it.
However my question was regarding my fingernails, which are falling off. What could be the cause and what tests should the doctor be performing?
Answered by Dr. Naveen Kumar 1 hour later

Thanks for writing back.

I apologize for misinterpreting your query. Falling off of finger nails also called as ‘Onychoptosis’ could be due to various reasons. Trauma and fungal infection are the commonest cause followed by hypothyroidism and rarely syphilis.

Following trauma there will be collection of blood below the nail causing the nail to be lifted off from the nail bed. The nail usually begins to discolor; indicating it has separated or begun to separate from the nail bed. In case of fungal infection, the fungi feeds over the keratin (the main source of formation of the nail) and starts destroying the nail from its nail bed, as a result of this there will be foul odor emitting from the nails.

Pertaining to this case, if there is no trauma involved, then it could be due to either fungal infection or thyroid hormone imbalance. You need to get thyroid hormone levels evaluated and also request for KOH mount of the nail scrapings to look for fungal growth.

Few precautionary measures to mention are:
> To keep the fingers and toes dry
> Avoid nail polish
> Application of antifungal cream

Hope I have answered your query, any more doubts you are welcome.

Above answer was peer-reviewed by
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