August 31, 2017

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Chiari Malformation

August 31, 2017

I was at a meeting today and afterward someone came up to me and asked if upper cervical chiropactic can help someone with Arnold Chiari. My answer was a confident yes! Arnold Chiari or Chiari for short is when the tonsils on the bottom of the Cerebellum drop down and crowd the foramen magnum of the skull (the hole through which the spinal cord exits).

 

This leads to a variety of symptoms as the tissue presses on areas of the brainstem and spinal cord. These may include headache, neck pain, upper extremity numbness, and paresthesias (the feeling of pins and needles). Because the cerebellum controls balance in the brain, unsteadiness and problems with balance are also extremely common. This may extend to similar symptoms like problems with motor skills, coordination, weakness, and dizziness. Those suffering from CM may experience other symptoms commonly associated with problems with brain such as difficulty swallowing, speech issues, problems with vision, and abnormal breathing.

 

 

 

 

The yellow arrow indicates the herniated tonsil. This part should stay above the horizontal yellow line.

 

 

 

 

 

 

 

 

Adjusting the atlas vertebrae is a novel approach that has proven effective. You might be asking “But how does adjusting the atlas help a brain problem?” There are multiple studies demonstrating the development of Chiari symptoms after a cervical trauma (i.e. whiplash) (1). Logically, if the area that received the trauma is treated, the symptoms should improve. This is supported by case studies as well as my own experience treating patients with this issue. The anatomy of the upper cervical spine is unique in its structure (no disc) and location (near the base of the skull/brain stem). The spinal cord at this level attaches to the bone (not true at other levels) so if the atlas is displaced then so is the spinal cord. When this happens, the flow of cerebral spinal fluid (CSF) is disrupted and becomes turbulent. This can create a vacuum effect that may draw the cerebellar tonsils down.

If you know anybody suffering from Chiari malformation, please send them our way. We may be able to help.

 

References

 1. A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash)
. Freeman MD, Rosa S, Harshfield D, Smith F, Bennett R, Centeno CJ, Kornel E, Nystrom A, Heffez D, Kohles S1. S.
Brain Inj. 2010;24(7-8):988-94.

 

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