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When is Chiari malformation diagnosis ascertained after cerebellar tonsils extension?

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Posted on Thu, 27 Jul 2017
Question: My question is, how far does it need to extend down to be considered Chiari? I know that this is something I should be discussing with my doctors but they blow everything off all the time.I have a boatload of problems right now which makes me a walking disaster. In my last head MRI, it was noted by the radiologist that I have mild cerebellar tonsillar ectopia with the tonsils extending down a few millimeters. It doesn't get into any more depth than that. I looked up what it was meant and it usually means Chiari Malformation 1. My niece had it with encephilitis and had to have surgery because of the build up of fluid on her brain. My question is, how far does it need to extend down to be considered Chiari? I know that this is something I should be discussing with my doctors but they blow everything off all the time. I literally have all the symptoms but I have been diagnosed with a bunch of other stuff to try and explain everything off. I had neck surgery in Sept 2014 for fusion of C5/C6. I still have neck pain all the time including pain at the base of my skull, at the back of my head to the point that I can't wear anything on my head because of the pain. I have pain racking my whole body and back down to my hips. I was diagnosed with fibromyalgia, myofascial pain syndrome, cervical spondylosis with myelopathy, radiculitis of the upper extremities, chronic daily migraines, chronic bilateral low back pain with bilateral sciatica, lumbar disc herniation with radiulopathy, right L5-S1, whole body pain, and the list goes on. There is also a couple small stable deep periventriclar signal abmnormalities, possibly nodular heterotopia. I also have congenital hypothyroidism with multiple nodules and a goiter on my thyroid. The medication is well controlled now.


Sorry. I forgot to mention a couple things that may contribute- I have frequent issues with various parts of my body going numb. Some things stay numb like my fingers and parts of my feet. Others come and go like the outside of my face, arms, parts of my legs and back. Somethings are just reduced. I also have IBS-D.
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Answered by Dr. Erion Spaho (1 hour later)
Brief Answer:
Six millimeters or more.

Detailed Answer:
Hello and thanks for using HealthcareMagic.

I have read your question and understand your concerns.

Extension down into foramen magnum of cerebellar tonsils 3-6 mm is considered as an intermediate condition between Chiari 1 malformation and normality, clinical correlation is necessary.

Six or more millimeters extension is considered as Chiari 1 malformation.

I think a good part of your symptoms are related to this displacement of cerebellar tonsils compressing brainstem and spinal cord.

A cervical spine MRI is also necessary to evaluate the possibility of associated syringomyelia.

If there is 6 mm displacement of cerebellar tonsils and Chiari 1 malformation is found as responsible for your symptoms, surgical decompression of the posterior fossa is necessary.

You need to see a Neurosurgeon about this issue.

Hope you found the answer helpful. Let me know if I could assist you further.

Take care.


Above answer was peer-reviewed by : Dr. Arnab Banerjee
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Answered by
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Dr. Erion Spaho

Neurologist, Surgical

Practicing since :2004

Answered : 3850 Questions

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When is Chiari malformation diagnosis ascertained after cerebellar tonsils extension?

Brief Answer: Six millimeters or more. Detailed Answer: Hello and thanks for using HealthcareMagic. I have read your question and understand your concerns. Extension down into foramen magnum of cerebellar tonsils 3-6 mm is considered as an intermediate condition between Chiari 1 malformation and normality, clinical correlation is necessary. Six or more millimeters extension is considered as Chiari 1 malformation. I think a good part of your symptoms are related to this displacement of cerebellar tonsils compressing brainstem and spinal cord. A cervical spine MRI is also necessary to evaluate the possibility of associated syringomyelia. If there is 6 mm displacement of cerebellar tonsils and Chiari 1 malformation is found as responsible for your symptoms, surgical decompression of the posterior fossa is necessary. You need to see a Neurosurgeon about this issue. Hope you found the answer helpful. Let me know if I could assist you further. Take care.