Chiari malformation is a structural abnormality in which the lower part of the brain (the cerebellar tonsils) extends through the opening at the base of the skull into the upper spinal canal. This displacement compresses the brainstem and cerebellum and can obstruct the normal flow of cerebrospinal fluid.
Chiari malformation is classified by severity. Type I, the most common form seen in adults, involves downward displacement of the cerebellar tonsils. Many people with mild Chiari malformation have no symptoms, while others develop progressive and debilitating problems.
Recognizing the Symptoms
Chiari symptoms often develop gradually and can mimic other conditions, sometimes leading to delayed diagnosis. The hallmark symptom is a headache at the back of the head that worsens with coughing, sneezing, or straining.
- Headaches at the base of the skull, worsened by Valsalva maneuvers
- Neck pain and stiffness
- Balance problems and difficulty with coordination
- Numbness or tingling in the hands and arms
- Difficulty swallowing or choking episodes
- Sleep apnea or irregular breathing patterns
- Ringing in the ears or dizziness
Getting a Proper Diagnosis
Chiari malformation is diagnosed with MRI of the brain and cervical spine. The MRI shows the position of the cerebellar tonsils relative to the skull base and can identify associated conditions such as syringomyelia (a fluid filled cavity within the spinal cord). Dr. Waldron evaluates the degree of tonsillar descent, CSF flow dynamics, and symptom severity to determine whether surgical intervention is recommended.