A Chiari Malformation is a brain condition that I see often as an upper cervical chiropractor. What is so unfortunate is that these malformations often go unreported! I can’t begin to tell you the number of times that I’ve seen people who have MRIs and a report that say “nothing is wrong … but then I take one 5-second look at their actual MRI scans, and there in black-and-white is a clear Chiari Malformation. In this 2-part article, I’m going to discuss a few things:
- What a Chiari Malformation is;
- The types of problems they can cause;
- The reason they go undetected so often (Part 2); and
- Treatment options (Part 2).
What is a Chiari Malformation?
Your brain and spinal cord are like a balloon with a string attached. Pull-on the string, and the balloon starts to sink downwards. A Chiari Malformation occurs when a portion of the brain descends out of the skull into the spinal canal.
Think of your central nervous system like a helium-filled balloon with a string attached. Your brain is the balloon, and your spinal cord is the string. Now imagine what would happen to the base of the balloon, which normally sits inside your skull, if you start to tug on the string.
The balloon would start to herniate downwards. That is a Chiari Malformation. Chiari Malformations are graded on a scale of Type I - Type IV based on how much of the brain is actually poking out. For adults, the normal limit of brain herniation is 4mm.
Anything beyond that is categorized as a Type I Chiari Malformation. If the brain herniates all the way down to the C1 and C2 upper cervical vertebrae (atlas or axis), then it is categorized as a Type II Malformation, also called an Arnold-Chiari Malformation.
There is an additional, special category called a Type 0 Chiari Malformation that occurs when there is no herniation >4mm, but the brain is still causing problems by restricting space within the skull. It is also known as cerebellar tonsillar ectopia (CTE). And as I will discuss shortly, these are the particular problems that I see very commonly that previously have done undiagnosed.
Chiari Malformations are traditionally believed to be congenital or developmental. In other words, they occur because of the way that your bones or nervous system develop before you were born or while you were growing up.
However, there is an increasing amount of research indicating that Chiari Malformations can be caused by whiplash-type injuries. A whiplash injury is any sudden snapping of your neck. It does not need to be caused in a car accident, but can also be caused by roller coaster rides, sports injuries, or any unexpected fall. in effect, the whiplash injury creates a sudden yank on that string (spinal cord), which pulls your balloon (brain) down through your skull.
A whiplash, concussion, or misalignment of the upper neck may be a massive contributing factor in the development of a Chiari Malformation. I’ve written many times before about these types of injuries and the terrible impact they have months, years, or decades down the track. …
You know, the ones where you are sore for a few days, but your doctor says that you “okay” without investigating the problem in proper detail? Those types of injuries, when the damage simply accumulates to the point where your nervous system simply can’t adapt to the stress anymore.
Our health culture is based on a fundamental lie, which is “If I feel good, everything must be fine.” While that is true for crisis or medical care, the reality is that when it comes to health, many conditions -may be including traumatic Chiari Malformations - would fare so much better with proper intervention at the time of injury.
What types of problems can a Chiari Malformation cause?
Imagine that you’ve gained a little weight over the past year, and you discover that your pants are fitting a little bit too tight. That is what happens when a portion of your brain sinks too low into your spinal canal, which is not big enough to accommodate the extra mass.
The most common part of the brain that descends into the opening is called the cerebellum, which is responsible for balance, coordination, and fine-movement. (Note: Specifically, it is a part of the cerebellum called the cerebellar tonsil that usually descends into the spinal canal, which is why medical radiologists or neurologists also call a Chiari Malformation a “tonsillar herniation” or as I mentioned previously “cerebellar tonsillar ectopia.”)
The brain (cerebellum, shown in blue) must not descend past the pink line. Anything more than 4mm is called a Chiari Malformation. This is a 6mm herniation that was not mentioned in the MRI report. As you may imagine, constriction of the cerebellum may cause dizziness, vertigo, and muscle weakness potentially in any part of the body. But that’s not all! The brainstem and associated cranial nerves (IX-XII) sit adjacent to the cerebellum and are subject also to pressure.
Disruption of these vital life centers can cause a host of serious health problems including difficulties with speech, swallowing, digestive, respiratory and cardiovascular health. There’s more still! The pressure created by the Chiari Malformation may block the normal flow of 1) blood into the brain; 2) blood out of the brain; and/or 3) cerebrospinal fluid (CSF), which is the fluid medium that cushions and nourishes the brain.
Blockage to the flow of any of these fluids can cause a build-up of pressure within the brain, leading to swelling on the brain (encephalopathy), swelling within the spinal cord (syringomyelia). These processes may be associated with chronic headaches, migraines, glaucoma, chronic fatigue syndrome, or fibromyalgia (which are collectively known as “myalgic encephalomyelitis”).
Disruption of normal CSF and venous flow may even contribute to a host of neurodegenerative conditions including multiple sclerosis, Alzheimer’s dementia, or Parkinson’s Syndrome. Now, there is something very important that I must discuss before we go any farther.
It is that many Chiari Malformations do not cause any problems at all! One study of over 12,000 MRIs identified that 30% of people with herniations greater than 5mm (Type I) did not experience any symptoms. (7) In other words, it appears that a Chiari Malformation by itself may not be the only factor to address if you are experiencing health problems.
What it implies is that the Chiari Malformation means that your body’s natural threshold to be able to adapt to stress is less. Metaphorically, if an average adult can drink 2 glasses of wine before feeling a little tipsy, a person with a Chiari Malformation can only drink half a glass before feeling wasted. This will be important when I come to the part on treatment options, and what you can do if you have a Chiari Malformation.
- Chiari and Syringomyelia Foundation. What is Chiari Malformation? http://csfinfo.org/education/patient-information/chiari-malformation/. Accessed 5 June 2018.
- Smith FW. Upright magnetic resonance imaging of the craniocervical junction. Smith FW, Dworkin JS (eds): The Craniocervical Syndrome and MRI. Basel, Karger, 2015, pp 33-47.
- Freeman MD, Rosa S, Harshfield D, et al. A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash). Brain Inj. 2010;24(7-8):988-94.
- Flanagan MF. The Downside of Upright Posture. Two Harbors Press, 2010.
- Flanagan MF. The role of the craniocervical junction in craniospinal hydrodynamics and neurodegenerative conditions. Neurology Research International, 2015; Article ID 794829: http://dx.doi.org/10.1155/2015/794829.
- Bradley WG. Cerebrospinal fluid physiology and its role in neurologic disease. Smith FW, Dworkin JS (eds): The Craniocervical Syndrome and MRI. Basel, Karger, 2015, pp 1-8 (DOI:10.1159/000365470).
- Elster AD, Chen MY. Chiari I malformations: a clinical and radiologic reappraisal. Radiology 1992;183:347-353.
- Rosa S, Baird JW. The craniocervical junction: observations regarding the relationship between misalignment, obstruction of cerebrospinal fluid flow, cerebellar tonsillar ectopia, and image-guided correction. Smith FW, Dworkin JS (eds): The Craniocervical Syndrome and MRI. Basel, Karger, 2015, pp 48-66 (DOI:10.1159/000365470).
- Wan MJ, Nomura H, Tator CH. Conversion to symptomatic Chiari I malformation after minor head or neck trauma. Neurosurgery. 2008 Oct;63(4):748-53; discussion 753. doi: 10.1227/01.NEU.0000325498.04975.C0.