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Best Arnold Chiari Malformation Treatment In Delhi NCR.

What is Arnold Chiari Malformation ?

Arnold-Chiari malformation, often simply called Chiari malformation (CM), is a structural defect in the cerebellum, the part of the brain that controls balance and coordination. In this condition, brain tissue extends down into the spinal canal. This occurs when the lower part of the cerebellum, called the cerebellar tonsils, is pushed through the foramen magnum, the opening at the base of the skull through which the spinal cord passes.

The pressure this puts on the cerebellum and brainstem can cause a variety of symptoms. Chiari malformations are often congenital, meaning they are present at birth, resulting from developmental issues during fetal growth. However, they can sometimes develop later in life due to injury, infection, or other conditions that cause excessive spinal fluid drainage.

Types of Arnold Chiari Malformation

There are several types of Chiari malformations, with Type I being the most common and often the least severe:

  • Type I Chiari Malformation: The lower part of the cerebellum (tonsils) extends into the spinal canal. Symptoms usually appear in late childhood or adulthood. Many people with Type I CM may not have any symptoms.
  • Type II Chiari Malformation (Arnold-Chiari malformation): A larger amount of cerebellar tissue, along with the brainstem, extends into the spinal canal. This type is usually associated with myelomeningocele, a type of spina bifida. It’s typically diagnosed in infancy or early childhood.
  • Type III Chiari Malformation: A rare and severe form where the cerebellum and brainstem protrude through an opening in the back of the skull. This often causes significant neurological problems.
  • Type IV Chiari Malformation: Involves an incomplete or underdeveloped cerebellum (cerebellar hypoplasia). The cerebellar tonsils may be in a normal position but the cerebellum itself is malformed.
Symptoms of Arnold Chiari Malformation

Symptoms of Chiari Malformation Type I can include:

  • Headaches: Often severe, located at the back of the head, and may be worsened by coughing, sneezing, or straining.
  • Neck pain
  • Dizziness and balance problems
  • Muscle weakness
  • Numbness or tingling in the arms and legs
  • Blurred or double vision
  • Difficulty swallowing, sometimes with gagging, choking, and vomiting
  • Speech changes, such as hoarseness
  • Ringing or buzzing in the ears (tinnitus)
  • Sleep apnea

Symptoms of Chiari Malformation Type II are often associated with myelomeningocele and can include:

  • Changes in breathing patterns
  • Trouble swallowing, such as gagging
  • Rapid downward eye movements
  • Weakness in the arms
Diagnosis & Treatment

Diagnosis typically involves a neurological examination and imaging tests, primarily MRI (Magnetic Resonance Imaging), which provides detailed images of the brain and spinal cord. A CT scan may also be used in some cases.

Treatment for Chiari malformation depends on the type, severity of symptoms, and presence of associated conditions.

  • Observation: If there are no or mild symptoms, a doctor may recommend regular monitoring with periodic exams and MRI scans.
  • Medications: Pain relievers can help manage headaches and neck pain.
  • Surgery: For symptomatic Chiari malformations, surgery is often recommended to relieve pressure on the cerebellum and spinal cord and restore the normal flow of cerebrospinal fluid. The most common surgery is posterior fossa decompression, which involves removing a small piece of bone at the back of the skull. Other surgical procedures may include laminectomy (removing part of the spinal column) or duraplasty (enlarging the covering of the brain). In some cases, a shunt may be needed to drain excess cerebrospinal fluid (hydrocephalus or syringomyelia).
  • Physical Therapy: Can help address symptoms like pain, muscle weakness, balance issues, and gait problems. Vestibular rehabilitation may be used for dizziness and balance issues.

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