When an individual complains of physical symptoms that are nebulous and commonplace, patients are often told that their complaints are psychosomatic, or that the symptoms are “all in their head.” Although this diagnosis recognizes the power of mental processes, on occasion the problem is a result of a brain deformity called chiari malformation.
Chiari malformation is most often congenital and occurs in slightly less than one in 1000 individuals, according to the American Association of Neurological Surgeons.
Some patients with Chiari experience symptoms similar to those of fibromyalgia and chronic fatigue syndrome, which are also challenging to diagnose and treat. “Chiari that goes undiagnosed for a lengthy time can lead to real psychological problems in some patients, making the condition even more problematic to treat,” said Ghassan Bejjani, MD, AANS spokesperson and an expert on Chiari.
Symptoms vary greatly depending on the type of Chiari and the patient’s own unique circumstances, but may include:
•Severe head and neck pain
•An occipital headache felt at the base of the skull that is made worse by coughing, sneezing, or straining
•Loss of pain and temperature sensation of the upper torso and arms
•Loss of muscle strength in the hands and arms
•Drop attacks – collapsing to the ground due to muscle weakness
•Double or blurred vision
•Hypersensitivity to bright lights
Surgical treatment of Chiari depends on the type of malformation. The benefits of surgery should always be weighed carefully against its risks. Although some patients experience a reduction in their symptoms, there is no guarantee that surgery will help every individual. Nerve damage that has already occurred usually cannot be reversed. Some surgical patients need repeat surgeries, while others may not achieve symptom relief.