AUTHOR OF CASE PRESENTATION: Monica L. Leverette
SUMMARY: Chiari malformations (CMs) are a condition in which brain tissue extends into the spinal canal. It occurs when part of the skull is abnormally small or misshapen, pressing on the brain and forcing it downward. CMs are structural defects in the cerebellum, the part of the brain that controls balance. Chiari malformations are uncommon, but improved imaging tests have led to more frequent diagnoses. There are two types of Chiari malformations. Type I develops as the skull and brain are growing. As a result, signs and symptoms may not occur until late childhood or adulthood. Chiari malformations Type II is the most common pediatric form, and is present at birth. The treatment of Chiari malformations depends on the form, severity and associated symptoms. Treatment options include regular monitoring, medications and surgery. In some cases, no treatment is needed. Many people with Chiari malformations have no signs or symptoms and don’t need treatment. Their condition is detected only when tests are performed or unrelated disorders.
Individuals with Chiari malformations may complain of neck pain, balance problems, muscle weakness, numbness or other abnormal feelings in the arms or legs, dizziness, vision problems, difficulty swallowing, ringing or buzzing in the ears, hearing loss, vomiting, insomnia, depression, or headache made worse by coughing or straining. Hand coordination and fine motor skills may be affected.
BACKGROUND: I thought this case was important because the signs and symptoms of Chiari malformations can be associated with so many other disorders that the Chiari malformations could be misdiagnosed, and could become life-threatening. And because Chiari malformations are uncommon, a person may think they just have a headache or neck pain or other symptoms that are associated with other disorders, and may never seek medical attention thinking the headache or neck pain will resolve on its own.
CASE PRESENTATION: Dizzy/Headache
HPI: Patient is here complaining of dizziness and headache that started recently. Patient was diagnosed with Chiari malformations in January of 2010. The patient had the same complaints then as she has currently. At that time, the plan for this patient included blood work, Echo, carotid and an EMG was ordered for the complaints of right upper extremity numbness. At the time of this visit, the patient reports the dizziness occurs off and on. Patient reports that it feels like the room is spinning around. Patient also complains of mild nausea associated with dizziness but no vomiting. No visual changes, no palpitations. Denies any fever or chills. Patient does complain of being tired lately, a little more than usual. Patient reports that she went to the ER twice for the dizziness.
PMH/PSH: High Cholesterol; Appendectomy; Breast Biopsy-Benign; Left Oophorectomy
FH: 1 brother-killed; 1 sister-MI deceased; 2 brothers- alive and well; 3 sisters-alive and well; Father-colon cancer deceased; Grandpa- cancer deceased; Mother-alive and well
MEDS: Ferrous Sulfate ER 325 mg once daily; Omega 3 Fish Oil 684mg-1200 TID; Omeprazole 20 mg capsule delay once daily, Vitamin D2 50,000 unit capsule once a week
ALLERGIES: No known allergies
SHx: No drinking; No drugs; No smoking
PHYSICAL EXAM FINDINGS:
Vitals: WEIGHT 167.8 |HEIGHT 62 |TEMP 97.9 |BP 120/90 |RESP 18 |PULSE 60 |BMI 30.7
General: Patient is alert, awake, and in no distress.
HEENT: Headache (5of 10). Throat was normal, TMs normal, no lymphadenopathy, and no thick nasal discharge.
Neck: Trachea midline. Neck supple; thyroid isthmus palpable, lobes not felt.
Chest/Lungs: Clear to auscultation, no crackles, wheezing, or rhonchi were noted.
Cardiovascular: Regular rate and rhythm, no murmurs or extra sounds noted. No JVD.
Abdomen: No tenderness, no masses, no organomegalies, no rebound tenderness, bowel…