The answer to yesterday’s mystery is … Chiari Malformation (type 1)! Superb job ED-RN, eileen, Dave, kmu, Shayna, ColorMaven, HarryS, Federica, Erin, ED Doc, Myra, Angelita, PC. Not an easy case this week!
Chiari Malformations are anatomic abnormalities of the back of the brain. In normal anatomy, the brain is encapsulated entirely within the skull, while the spinal cord exits downward through a hole in the back of the skull. In a Chiari Malformation, the back of the brain called the cerebellum slips down through the hole along with the spinal cord. There are four different classifications of this anomaly, with varying degrees of displacement of the brain. In the most common type I presented here, patients can live into adulthood without a diagnosis.
When patients with this malformation cough, sneeze, move their bowels, or perform any other activity that increases pressure in the body, this may bring on the classic Chiari headache. Straining puts pressure on the brain that may cause it to squeeze against the tiny hole in the skull, causing pain. Neurologic symptoms, such as dizziness, weakness, numbness, clumsiness, and visual changes, can accompany Chiari malformations depending on what part of the brain is affected.
Treatment of Chiari malformations is controversial. Some can be managed simply with pain medications to relieve the headaches. If that fails, neurosurgery is an option. Surgeons can remove the part of the skull that is putting pressure on the brain – unbelievable, right? I’ve received a large influx of MMM suggestions lately – if you’d like to see a disease near and dear to your heart featured, let me know: mdtobeblog (at) gmail (dot) com.