How to manage Chiari malformation type 1 symptoms?

Question

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 (Coronavirus Disease) almost seven months ago. I have had headaches, brain fog, memory loss, falling, neck and ear pain, tinnitus, migraine, and nausea since that time. I had an MRI of the brain with contrast, and the reading showed a 0.7-inch Chiari type 1.

Also, I had an MRI FLAIR and DWI MRI done. I am meeting with my neurologist next week, but I wanted to get 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 0.7 inches 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 a 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, and the pituitary gland is unremarkable on T1 sagittal images. I had also done CRP and ESR tests last week, with the values being 21.3 and 46, respectively.

I am currently taking Synthroid, Cytomel, Pristiq, vitamin D, B12, and Magnesium for leg restlessness.

Please guide.

Answer 1

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-Chiari type 1. You need to do a screening magnetic resonance imaging (MRI) of the spine to look for associated findings like a 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 postoperatively.

I hope this helps you.

Thank you.