Arnold-Chiari malformation involves the downward displacement of brain tissue through the foramen magnum. It can cause a range of symptoms from neck pain to difficulty swallowing. Diagnosis involves imaging tests like MRI. Treatment may include decompression surgery to create more space in the skull as well as shunt procedures to drain excess spinal fluid for conditions like hydrocephalus. Management requires a multidisciplinary team and surgery often provides symptom relief.
This document describes Chiari malformation, specifically Chiari type I and II. It discusses the presentation, diagnosis, and treatment of a 34-year-old female patient presenting with progressive arm weakness, shoulder pain, and headaches exacerbated by coughing. Examination found reduced sensitivity in her arms. MRI confirmed Chiari type I malformation with tonsillar herniation. The patient underwent posterior fossa decompression surgery, with improvement in symptoms at 6-month follow up. Chiari malformations cause hindbrain herniation and obstruction of CSF flow, often requiring surgery to enlarge the posterior fossa.
Chiari malformations are a group of hindbrain abnormalities involving the rhombencephalon and cerebrospinal fluid junction. There are four main types of Chiari malformations described. Chiari type I involves tonsillar herniation below the foramen magnum without brainstem herniation. Chiari type II involves herniation of the brainstem, cerebellar vermis, and fourth ventricle and is associated with myelomeningocele. Chiari type III is an occipital encephalocele with similar anomalies to type II. Chiari type IV involves cerebellar hypoplasia without herniation. Clinical features of Chiari I can include headache, numbness, and
Tethered Cord Syndrome is caused by abnormal tension on the spinal cord due to a low-lying conus medullaris. It can present from infancy through adulthood with a variety of motor, sensory, urological or orthopedic symptoms depending on age. While not all anatomical tethering causes symptoms, surgical release is recommended for patients experiencing progression of neurological dysfunction or new symptoms attributed to increased cord tension over time.
- Cerebral herniation occurs when brain tissue shifts from its normal position inside the skull due to increased intracranial pressure. This is a medical emergency.
- Common causes are cerebral edema, hematoma, stroke, tumor, and infections.
- There are several types of cerebral herniations including subfalcine, central, uncal, and tonsillar. Uncal herniation can cause pupillary dilation and decreased consciousness as it compresses the midbrain.
- Increased intracranial pressure can be managed medically with positioning, hyperventilation, hyperosmolar therapy, and induced hypertension or surgically with decompressive craniectomy.
Chiari malformation is a neurological disorder where the cerebellum descends from the skull, putting pressure on the brain and spine. Common symptoms include headaches, vision problems, balance issues, and muscle weakness. Treatment may include conservative management or posterior fossa decompression surgery to relieve compression. Life with Chiari can be challenging, as symptoms vary daily and simple tasks may cause exhaustion. Support and understanding from others is important.
Due to stretching forces placed on individual nerve cells
Pathology distributed throughout brain
Types
Concussion
Diffuse Axonal Injury (Moderate to Severe)
The Dandy-Walker complex is a rare congenital brain malformation characterized by cystic dilation of the 4th ventricle and partial or complete absence of the cerebellar vermis. It ranges from mega cisterna magna to Dandy-Walker variant to Dandy-Walker malformation based on severity. Associated anomalies are common. The cause is unknown but likely involves abnormal development of the hindbrain. Treatment involves managing hydrocephalus, often with shunt procedures. Prognosis depends on severity and associated anomalies, with higher mortality and developmental delays in more severe forms.
This document provides an overview of traumatic brain injury (TBI), including its definition, pathophysiology, types (closed and open head injuries), specific injuries (contusions, hematomas, fractures), assessment (Glasgow Coma Scale), management (preventing secondary brain injury, ICP monitoring and treatment), and long-term outcomes (cognitive deficits, epilepsy, headaches). It describes the primary and secondary injury mechanisms of TBI, including diffuse axonal injury. Imaging and diagnostic criteria for different types of brain injuries are outlined. Guidelines for initial evaluation, monitoring, and medical and surgical management of increased ICP are also reviewed.
This document describes Chiari malformation, specifically Chiari type I and II. It discusses the presentation, diagnosis, and treatment of a 34-year-old female patient presenting with progressive arm weakness, shoulder pain, and headaches exacerbated by coughing. Examination found reduced sensitivity in her arms. MRI confirmed Chiari type I malformation with tonsillar herniation. The patient underwent posterior fossa decompression surgery, with improvement in symptoms at 6-month follow up. Chiari malformations cause hindbrain herniation and obstruction of CSF flow, often requiring surgery to enlarge the posterior fossa.
Chiari malformations are a group of hindbrain abnormalities involving the rhombencephalon and cerebrospinal fluid junction. There are four main types of Chiari malformations described. Chiari type I involves tonsillar herniation below the foramen magnum without brainstem herniation. Chiari type II involves herniation of the brainstem, cerebellar vermis, and fourth ventricle and is associated with myelomeningocele. Chiari type III is an occipital encephalocele with similar anomalies to type II. Chiari type IV involves cerebellar hypoplasia without herniation. Clinical features of Chiari I can include headache, numbness, and
Tethered Cord Syndrome is caused by abnormal tension on the spinal cord due to a low-lying conus medullaris. It can present from infancy through adulthood with a variety of motor, sensory, urological or orthopedic symptoms depending on age. While not all anatomical tethering causes symptoms, surgical release is recommended for patients experiencing progression of neurological dysfunction or new symptoms attributed to increased cord tension over time.
- Cerebral herniation occurs when brain tissue shifts from its normal position inside the skull due to increased intracranial pressure. This is a medical emergency.
- Common causes are cerebral edema, hematoma, stroke, tumor, and infections.
- There are several types of cerebral herniations including subfalcine, central, uncal, and tonsillar. Uncal herniation can cause pupillary dilation and decreased consciousness as it compresses the midbrain.
- Increased intracranial pressure can be managed medically with positioning, hyperventilation, hyperosmolar therapy, and induced hypertension or surgically with decompressive craniectomy.
Chiari malformation is a neurological disorder where the cerebellum descends from the skull, putting pressure on the brain and spine. Common symptoms include headaches, vision problems, balance issues, and muscle weakness. Treatment may include conservative management or posterior fossa decompression surgery to relieve compression. Life with Chiari can be challenging, as symptoms vary daily and simple tasks may cause exhaustion. Support and understanding from others is important.
Due to stretching forces placed on individual nerve cells
Pathology distributed throughout brain
Types
Concussion
Diffuse Axonal Injury (Moderate to Severe)
The Dandy-Walker complex is a rare congenital brain malformation characterized by cystic dilation of the 4th ventricle and partial or complete absence of the cerebellar vermis. It ranges from mega cisterna magna to Dandy-Walker variant to Dandy-Walker malformation based on severity. Associated anomalies are common. The cause is unknown but likely involves abnormal development of the hindbrain. Treatment involves managing hydrocephalus, often with shunt procedures. Prognosis depends on severity and associated anomalies, with higher mortality and developmental delays in more severe forms.
This document provides an overview of traumatic brain injury (TBI), including its definition, pathophysiology, types (closed and open head injuries), specific injuries (contusions, hematomas, fractures), assessment (Glasgow Coma Scale), management (preventing secondary brain injury, ICP monitoring and treatment), and long-term outcomes (cognitive deficits, epilepsy, headaches). It describes the primary and secondary injury mechanisms of TBI, including diffuse axonal injury. Imaging and diagnostic criteria for different types of brain injuries are outlined. Guidelines for initial evaluation, monitoring, and medical and surgical management of increased ICP are also reviewed.
Arteriovenous Malformation (AVM) of BrainDhaval Shukla
Arteriovenous malformations (AVMs) of the brain are abnormal connections between arteries and veins in the brain that bypass the normal circulation. The cause of AVMs is unknown, though they are usually congenital. Symptoms vary depending on the location of the AVM and include brain hemorrhage in over 50% of cases, seizures in 20-25% of cases, and other neurological issues. Diagnosis involves CT, MRI, and cerebral angiogram imaging. Treatment options include surgery for accessible and smaller AVMs, stereotactic radiosurgery for smaller inaccessible ones, and endovascular procedures like using coils for parts of larger AVMs. Outcomes depend on the treatment, with surgery offering up to
This document discusses normal pressure hydrocephalus (NPH). It provides a historical overview of NPH and describes the classic triad of symptoms as gait disturbance, urinary incontinence, and dementia. Diagnostic criteria including brain imaging findings and response to lumbar puncture are outlined. Surgical treatment involves placing a shunt to drain cerebrospinal fluid, with variable response rates reported. Prognostic factors and long-term outcomes are also discussed.
Hydrocephalus is a condition where there is excessive accumulation of cerebrospinal fluid (CSF) in the brain, resulting in increased pressure on brain tissues. It occurs when there is an imbalance between the production and absorption of CSF, blocking its flow. Symptoms vary depending on age but can include headache, nausea, vision issues. It is diagnosed using brain imaging and treated primarily by surgically inserting a shunt to drain CSF out of the brain. Prognosis depends on cause and treatment success, though many children with hydrocephalus can lead normal lives with treatment.
Normal pressure hydrocephalus (NPH) is a reversible cause of dementia characterized by the classic triad of dementia, gait disturbance, and urinary incontinence. It is caused by excess cerebrospinal fluid in the brain's ventricles without increased fluid pressure. NPH typically affects older adults and can be diagnosed using criteria including an evaluation of symptoms, imaging scans, and lumbar puncture results. Treatment involves CSF shunting procedures, which can significantly improve symptoms in around 60% of NPH patients. Prognosis is generally good with sustained improvement possible after surgery, though shunt complications do occur in around 38% of cases.
Vestibular schwannomas, meningiomas, and epidermoid cysts are the most common tumors found in the cerebellopontine angle. They typically present with symptoms of cranial nerve dysfunction such as hearing loss, vertigo, and facial numbness. MRI is the gold standard for diagnosis and shows the location and size of the tumor. Treatment involves surgical resection while attempting to preserve cranial nerve function, with the goal of complete removal while minimizing complications.
This document discusses the anatomy, imaging, classification, and treatment of various cervical vertebral anomalies. It begins with an overview of the normal anatomy of the atlantoaxial joint and landmarks seen on imaging. It then discusses various congenital and acquired bony and soft tissue anomalies that can occur in this region, including platybasia, basilar invagination, occipitalization of the atlas, and atlantoaxial dislocation. Imaging criteria and classifications for these conditions are provided. Common associated findings like Chiari malformation and syringomyelia are also mentioned. The document concludes with sections on clinical presentation and evaluation of these cervical vertebral anomalies.
1. The cardinal signs of cerebellar dysfunction are ataxia, tremor, hypotonia, and asthenia. Tests include finger-nose coordination, rapid alternating hand movements, and gait.
2. Cerebellar lesions can cause dysarthria, scanning speech, nystagmus, and impaired eye movements like dysmetric saccades.
3. Clinical exams test arm and leg coordination through tasks like finger tapping, heel-shin rubbing, and tandem walking. Hypotonia is shown through floppy posture and pendular reflexes. Strength and endurance may also be reduced.
The craniovertebral junction (CVJ) refers collectively to the occiput, atlas, axis, and supporting ligaments. It is a transition zone between the mobile cranium and spinal column, enclosing the soft tissue structures of the cervicomedullary junction. The CVJ has important implications for embryology, anatomy, classification of anomalies, investigations, and clinical management. Anomalies can involve bony, soft tissue, arterial, and neural structures in this region. A variety of imaging modalities like X-rays, CT, MRI are used to classify and characterize CVJ anomalies.
Wallenberg syndrome, also known as lateral medullary infarction, is caused by occlusion of the posterior inferior cerebellar artery, which supplies blood to the lateral medulla. This leads to vertigo, abnormal eye movements, Horner's syndrome on one side, ataxia of the limb on the same side, and dissociated sensory loss. The condition is usually due to atherosclerosis but can also result from traumatic vertebral artery dissection. MRI and MRA are used to diagnose the infraction and rule out arterial dissection.
1) Normal pressure hydrocephalus (NPH) is characterized by abnormal gait, urinary incontinence, and dementia. It is most common in the elderly and can be caused by conditions like subarachnoid hemorrhage.
2) Diagnosis involves evaluating symptoms, imaging tests showing disproportionate ventricle enlargement, and tests like lumbar puncture to check CSF pressure and flow.
3) Treatment usually involves surgically placing a CSF shunt if symptoms improve with temporary drainage, with benefits seen in 50-61% of cases but also a high risk of complications.
Diffuse axonal injury is caused by shearing forces within the brain during traumatic injury that stretch and rupture axons. It is present in over 70% of moderate to severe traumatic brain injury cases and often occurs alongside hematomas or contusions. While difficult to detect on initial CT scans, diffuse axonal injury can be seen on MRI as lesions in white matter tracts of varying severity. Management involves initial resuscitation and maintaining normal physiology, with close monitoring of intracranial pressure and cerebral perfusion pressure to control swelling and prevent secondary injury. Prognosis depends on factors like age, brainstem involvement, and initial severity, but recovery to a good quality of life is possible despite diffuse axonal injury.
This document discusses cerebral herniation syndromes which occur when increased intracranial pressure causes brain tissue to be squeezed through openings in the skull. It describes the four main types of herniation - subfalcine, central/downward transtentorial, temporal transtentorial/uncal, and cerebellar tonsillar. Clinical signs and prognosis are provided for each type of herniation. The Monro-Kellie doctrine is also summarized, which states that the intracranial compartment has a fixed volume, and increases in any component can increase intracranial pressure.
Microvascular Decompression is a surgical procedure used to treat trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia caused by compression of cranial nerves by blood vessels. The procedure involves using a microscope to identify the compressing blood vessel and place a small piece of Teflon between the nerve and vessel to relieve compression. It provides long-term pain relief with few complications when performed by an experienced surgeon for patients who have not responded well to medications.
A simplified description of basal ganglia stroke to help understand the clinical scenarios where patients present with neurological symptoms not clearly pointing towards possibility of stroke.
chiari or arnold chiari malformations, various types and pathophysiology, radiological and clinical presentation of the types, signs symptoms, investigations and treatment of these malformations both conservative and surgical. considerations and controversiies in management of chiari malformation associated with various conditions.
Well descriptive power point presentation for fresh neurosurgery residents across the world with very basic knowledge of Chiari malformations and its types and principles of the management and management of its associations.
Dr. Yashveer Singh discusses the history and techniques of shunt surgery. Key points include:
- Shunt surgery diverts cerebrospinal fluid (CSF) from the brain ventricles to another site to treat hydrocephalus. It has evolved from early 20th century drainage techniques to modern shunt systems using silicone catheters and programmable valves.
- Careful planning is required to determine the optimal insertion sites for ventricular and distal catheters based on patient history and anatomy. Meticulous surgical technique and attention to details can reduce complications like infection and blockage.
- The goals of shunt surgery are to achieve normal intracranial pressure and neurological function while
Arnold Chiari Malformation And Dandy Walker Syndrome.pptxAhBj1
Arnold Chiari Malformation, also known as Chiari type II malformation, is one of a group of brain malformations affecting the cerebellum. Named after Hans Chiari and Julius Arnold, the pathologists who first described the group of malformations. This condition is almosNormally the cerebellum and parts of the brain stem sit in an indented space at the lower rear of the skull, above the foramen magnum (a funnel-like opening to the canal). When part of the cerebellum is located below the foramen magnum, it is called a Chiari malformation. In Arnold Chiari Malformation, both cerebellar and brain stem tissue protrude into the foramen magnum and the cerebellar vermis (the nerve tissue that connects the two halves of the cerebellum) may be only partially complete or absent
t always associated with myelomeningocele, the most serious form of spina bifida
Dandy-Walker Syndrome (DWS) is a congenital (happening before birth) condition where the cerebellum does not develop normally. The cerebellum is an area at the back of the brain that controls movement and balance.
With DWS, parts of the cerebellum may never develop or may be very small. Other parts of the cerebellum become filled with fluid or develop small masses of fluid (cysts). In most cases, a build-up of fluid inside the skull causes the head to get bigger than it should.
Syringomyelia is a condition where a cyst, called a syrinx, develops in the spinal cord. It most commonly affects the lower cervical spine. It is often associated with abnormalities of the skull or spinal column. The majority of cases are linked to Chiari malformation type 1, where the cerebellar tonsils are displaced into the spinal canal. Symptoms vary depending on the location of the syrinx but can include pain, loss of sensation, muscle weakness or atrophy, and autonomic dysfunction. Diagnosis is made using imaging like MRI. Treatment involves surgery to decompress pressure on the spinal cord like laminectomy with the goal of resolving the syrinx.
This document provides an overview of Arnold Chiari Malformation with Syringomyelia, including:
1. A brief history of the discovery and classification of Chiari malformation and syringomyelia.
2. An explanation of the anatomy and physiology related to Chiari malformation, including the four types of Chiari malformation.
3. A discussion of common signs and symptoms, including headaches, dizziness, pain, and neurological problems.
4. Details on diagnosis using imaging like MRI and treatment options like decompression surgery.
Radiological findings of congenital anomalies of the spine and spinal cordDr. Armaan Singh
This document discusses radiological findings of congenital anomalies of the spine and spinal cord. It begins by defining spinal dysraphisms as congenital abnormalities and reviews normal spinal development. The most common anomalies are spinal dysraphism and caudal spinal anomalies. Diagnosis can be made prenatally, at birth, in childhood, or adulthood using imaging techniques like MRI. It then discusses specific anomalies in detail like myelomeningocele, lipomyelocele, Chiari malformations, and closed spinal dysraphisms.
This document discusses spina bifida, a birth defect involving the neural tube where the spinal cord fails to close properly. It describes the three main types - spina bifida occulta, cystica (myelomeningocele), and meningocele. Signs and symptoms vary depending on location and severity of the defect but can include paralysis, loss of sensation, bowel/bladder issues, and cognitive problems. Treatment involves early surgery to repair the opening along with lifelong management of symptoms and secondary complications. Spinal cord injuries are also discussed, covering causes, classifications, regional effects, and long-term management strategies.
Arteriovenous Malformation (AVM) of BrainDhaval Shukla
Arteriovenous malformations (AVMs) of the brain are abnormal connections between arteries and veins in the brain that bypass the normal circulation. The cause of AVMs is unknown, though they are usually congenital. Symptoms vary depending on the location of the AVM and include brain hemorrhage in over 50% of cases, seizures in 20-25% of cases, and other neurological issues. Diagnosis involves CT, MRI, and cerebral angiogram imaging. Treatment options include surgery for accessible and smaller AVMs, stereotactic radiosurgery for smaller inaccessible ones, and endovascular procedures like using coils for parts of larger AVMs. Outcomes depend on the treatment, with surgery offering up to
This document discusses normal pressure hydrocephalus (NPH). It provides a historical overview of NPH and describes the classic triad of symptoms as gait disturbance, urinary incontinence, and dementia. Diagnostic criteria including brain imaging findings and response to lumbar puncture are outlined. Surgical treatment involves placing a shunt to drain cerebrospinal fluid, with variable response rates reported. Prognostic factors and long-term outcomes are also discussed.
Hydrocephalus is a condition where there is excessive accumulation of cerebrospinal fluid (CSF) in the brain, resulting in increased pressure on brain tissues. It occurs when there is an imbalance between the production and absorption of CSF, blocking its flow. Symptoms vary depending on age but can include headache, nausea, vision issues. It is diagnosed using brain imaging and treated primarily by surgically inserting a shunt to drain CSF out of the brain. Prognosis depends on cause and treatment success, though many children with hydrocephalus can lead normal lives with treatment.
Normal pressure hydrocephalus (NPH) is a reversible cause of dementia characterized by the classic triad of dementia, gait disturbance, and urinary incontinence. It is caused by excess cerebrospinal fluid in the brain's ventricles without increased fluid pressure. NPH typically affects older adults and can be diagnosed using criteria including an evaluation of symptoms, imaging scans, and lumbar puncture results. Treatment involves CSF shunting procedures, which can significantly improve symptoms in around 60% of NPH patients. Prognosis is generally good with sustained improvement possible after surgery, though shunt complications do occur in around 38% of cases.
Vestibular schwannomas, meningiomas, and epidermoid cysts are the most common tumors found in the cerebellopontine angle. They typically present with symptoms of cranial nerve dysfunction such as hearing loss, vertigo, and facial numbness. MRI is the gold standard for diagnosis and shows the location and size of the tumor. Treatment involves surgical resection while attempting to preserve cranial nerve function, with the goal of complete removal while minimizing complications.
This document discusses the anatomy, imaging, classification, and treatment of various cervical vertebral anomalies. It begins with an overview of the normal anatomy of the atlantoaxial joint and landmarks seen on imaging. It then discusses various congenital and acquired bony and soft tissue anomalies that can occur in this region, including platybasia, basilar invagination, occipitalization of the atlas, and atlantoaxial dislocation. Imaging criteria and classifications for these conditions are provided. Common associated findings like Chiari malformation and syringomyelia are also mentioned. The document concludes with sections on clinical presentation and evaluation of these cervical vertebral anomalies.
1. The cardinal signs of cerebellar dysfunction are ataxia, tremor, hypotonia, and asthenia. Tests include finger-nose coordination, rapid alternating hand movements, and gait.
2. Cerebellar lesions can cause dysarthria, scanning speech, nystagmus, and impaired eye movements like dysmetric saccades.
3. Clinical exams test arm and leg coordination through tasks like finger tapping, heel-shin rubbing, and tandem walking. Hypotonia is shown through floppy posture and pendular reflexes. Strength and endurance may also be reduced.
The craniovertebral junction (CVJ) refers collectively to the occiput, atlas, axis, and supporting ligaments. It is a transition zone between the mobile cranium and spinal column, enclosing the soft tissue structures of the cervicomedullary junction. The CVJ has important implications for embryology, anatomy, classification of anomalies, investigations, and clinical management. Anomalies can involve bony, soft tissue, arterial, and neural structures in this region. A variety of imaging modalities like X-rays, CT, MRI are used to classify and characterize CVJ anomalies.
Wallenberg syndrome, also known as lateral medullary infarction, is caused by occlusion of the posterior inferior cerebellar artery, which supplies blood to the lateral medulla. This leads to vertigo, abnormal eye movements, Horner's syndrome on one side, ataxia of the limb on the same side, and dissociated sensory loss. The condition is usually due to atherosclerosis but can also result from traumatic vertebral artery dissection. MRI and MRA are used to diagnose the infraction and rule out arterial dissection.
1) Normal pressure hydrocephalus (NPH) is characterized by abnormal gait, urinary incontinence, and dementia. It is most common in the elderly and can be caused by conditions like subarachnoid hemorrhage.
2) Diagnosis involves evaluating symptoms, imaging tests showing disproportionate ventricle enlargement, and tests like lumbar puncture to check CSF pressure and flow.
3) Treatment usually involves surgically placing a CSF shunt if symptoms improve with temporary drainage, with benefits seen in 50-61% of cases but also a high risk of complications.
Diffuse axonal injury is caused by shearing forces within the brain during traumatic injury that stretch and rupture axons. It is present in over 70% of moderate to severe traumatic brain injury cases and often occurs alongside hematomas or contusions. While difficult to detect on initial CT scans, diffuse axonal injury can be seen on MRI as lesions in white matter tracts of varying severity. Management involves initial resuscitation and maintaining normal physiology, with close monitoring of intracranial pressure and cerebral perfusion pressure to control swelling and prevent secondary injury. Prognosis depends on factors like age, brainstem involvement, and initial severity, but recovery to a good quality of life is possible despite diffuse axonal injury.
This document discusses cerebral herniation syndromes which occur when increased intracranial pressure causes brain tissue to be squeezed through openings in the skull. It describes the four main types of herniation - subfalcine, central/downward transtentorial, temporal transtentorial/uncal, and cerebellar tonsillar. Clinical signs and prognosis are provided for each type of herniation. The Monro-Kellie doctrine is also summarized, which states that the intracranial compartment has a fixed volume, and increases in any component can increase intracranial pressure.
Microvascular Decompression is a surgical procedure used to treat trigeminal neuralgia, hemifacial spasm, and glossopharyngeal neuralgia caused by compression of cranial nerves by blood vessels. The procedure involves using a microscope to identify the compressing blood vessel and place a small piece of Teflon between the nerve and vessel to relieve compression. It provides long-term pain relief with few complications when performed by an experienced surgeon for patients who have not responded well to medications.
A simplified description of basal ganglia stroke to help understand the clinical scenarios where patients present with neurological symptoms not clearly pointing towards possibility of stroke.
chiari or arnold chiari malformations, various types and pathophysiology, radiological and clinical presentation of the types, signs symptoms, investigations and treatment of these malformations both conservative and surgical. considerations and controversiies in management of chiari malformation associated with various conditions.
Well descriptive power point presentation for fresh neurosurgery residents across the world with very basic knowledge of Chiari malformations and its types and principles of the management and management of its associations.
Dr. Yashveer Singh discusses the history and techniques of shunt surgery. Key points include:
- Shunt surgery diverts cerebrospinal fluid (CSF) from the brain ventricles to another site to treat hydrocephalus. It has evolved from early 20th century drainage techniques to modern shunt systems using silicone catheters and programmable valves.
- Careful planning is required to determine the optimal insertion sites for ventricular and distal catheters based on patient history and anatomy. Meticulous surgical technique and attention to details can reduce complications like infection and blockage.
- The goals of shunt surgery are to achieve normal intracranial pressure and neurological function while
Arnold Chiari Malformation And Dandy Walker Syndrome.pptxAhBj1
Arnold Chiari Malformation, also known as Chiari type II malformation, is one of a group of brain malformations affecting the cerebellum. Named after Hans Chiari and Julius Arnold, the pathologists who first described the group of malformations. This condition is almosNormally the cerebellum and parts of the brain stem sit in an indented space at the lower rear of the skull, above the foramen magnum (a funnel-like opening to the canal). When part of the cerebellum is located below the foramen magnum, it is called a Chiari malformation. In Arnold Chiari Malformation, both cerebellar and brain stem tissue protrude into the foramen magnum and the cerebellar vermis (the nerve tissue that connects the two halves of the cerebellum) may be only partially complete or absent
t always associated with myelomeningocele, the most serious form of spina bifida
Dandy-Walker Syndrome (DWS) is a congenital (happening before birth) condition where the cerebellum does not develop normally. The cerebellum is an area at the back of the brain that controls movement and balance.
With DWS, parts of the cerebellum may never develop or may be very small. Other parts of the cerebellum become filled with fluid or develop small masses of fluid (cysts). In most cases, a build-up of fluid inside the skull causes the head to get bigger than it should.
Syringomyelia is a condition where a cyst, called a syrinx, develops in the spinal cord. It most commonly affects the lower cervical spine. It is often associated with abnormalities of the skull or spinal column. The majority of cases are linked to Chiari malformation type 1, where the cerebellar tonsils are displaced into the spinal canal. Symptoms vary depending on the location of the syrinx but can include pain, loss of sensation, muscle weakness or atrophy, and autonomic dysfunction. Diagnosis is made using imaging like MRI. Treatment involves surgery to decompress pressure on the spinal cord like laminectomy with the goal of resolving the syrinx.
This document provides an overview of Arnold Chiari Malformation with Syringomyelia, including:
1. A brief history of the discovery and classification of Chiari malformation and syringomyelia.
2. An explanation of the anatomy and physiology related to Chiari malformation, including the four types of Chiari malformation.
3. A discussion of common signs and symptoms, including headaches, dizziness, pain, and neurological problems.
4. Details on diagnosis using imaging like MRI and treatment options like decompression surgery.
Radiological findings of congenital anomalies of the spine and spinal cordDr. Armaan Singh
This document discusses radiological findings of congenital anomalies of the spine and spinal cord. It begins by defining spinal dysraphisms as congenital abnormalities and reviews normal spinal development. The most common anomalies are spinal dysraphism and caudal spinal anomalies. Diagnosis can be made prenatally, at birth, in childhood, or adulthood using imaging techniques like MRI. It then discusses specific anomalies in detail like myelomeningocele, lipomyelocele, Chiari malformations, and closed spinal dysraphisms.
This document discusses spina bifida, a birth defect involving the neural tube where the spinal cord fails to close properly. It describes the three main types - spina bifida occulta, cystica (myelomeningocele), and meningocele. Signs and symptoms vary depending on location and severity of the defect but can include paralysis, loss of sensation, bowel/bladder issues, and cognitive problems. Treatment involves early surgery to repair the opening along with lifelong management of symptoms and secondary complications. Spinal cord injuries are also discussed, covering causes, classifications, regional effects, and long-term management strategies.
The document discusses a case study of a 13-year-old female patient who suffered a traumatic brain injury from a vehicular accident. She was brought to the hospital and underwent an emergency craniectomy surgery to remove an epidural hematoma (blood clot between the skull and dura). An epidural hematoma can cause increased pressure and swelling of the brain if not removed surgically. The patient came from a low-income family and was the main income earner to help support her siblings. The document provides background information on the patient's medical history and injury as well as definitions of relevant anatomical and medical terms.
This document discusses neural tube defects, which result from failure of the neural tube to close during early development. It describes the classification, diagnosis, investigations, management, and prevention of various neural tube defects including anencephaly, encephalocele, spina bifida, meningocele, and myelomeningocele. Prenatal screening and folic acid supplementation are important for prevention, while management requires a multidisciplinary approach to address physical, developmental, and cognitive issues.
This document discusses neural tube defects (NTDs), which are congenital malformations of the brain and spinal cord caused by improper closure of the neural tube early in embryonic development, usually due to folic acid deficiency. It defines various types of NTDs including spina bifida, encephalocele, myelomeningocele, anencephaly, and tethered cord syndrome. For each type, it describes the pathogenesis, clinical presentation, diagnostic evaluation, and management approaches including surgery, bracing, physical therapy, and shunting procedures. Genetic and environmental risk factors are also discussed. The document provides a detailed overview of NTDs for medical professionals.
Neural tube defects are birth defects of the brain, spine, or spinal cord. They happen in the first month of pregnancy, often before a woman even knows that she is pregnant. The two most common neural tube defects are spina bifida and anencephaly.
Presentation1.pptx, congenital malformation of the brain.Abdellah Nazeer
More than 2000 congenital brain malformations have been described. Magnetic resonance imaging is useful for studying these conditions. The document provides an overview of important congenital brain malformations, including disorders of organogenesis like Chiari malformations, holoprosencephaly, and cephaloceles. Disorders of histogenesis and cytogenesis such as neurocutaneous syndromes, vascular malformations, and tumors are also discussed. The imaging features of various malformations are presented to aid diagnosis.
This document discusses Chiari malformations, which occur during fetal development and involve downward displacement of the cerebellar tonsils. It describes the symptoms, diagnosis via imaging, surgical treatment involving decompression, and risks/outcomes. Chiari I malformation involves tonsillar herniation below the foramen magnum, while Chiari II occurs in myelomeningocele patients. Surgery aims to relieve pressure and reduce syrinx size, with over 90% success rates though younger patients pose greater challenges.
This file is one of my medical PPT series ,mainly intended for medical students. Information and pictures are highly organized to serve this aim. All the credits of info & pics are reserved for their owners.
Unit 5 Child with Congenital Disorders.pptxRenitaRichard
Congenital anomalies refer to structural or functional abnormalities present at birth. This document discusses several common congenital anomalies including spina bifida, meningocele, hydrocephalus, cerebral palsy, and cleft lip and cleft palate. For each condition, the document defines it, discusses causes, signs and symptoms, diagnosis, treatment, and potential complications. Surgeries are often needed to repair defects, while other treatments may include shunts, braces, physical therapy, or speech therapy depending on the condition. Managing congenital anomalies requires a multidisciplinary care approach.
This document summarizes several pediatric neurologic disorders including hydrocephalus, neural tube defects, cerebral palsy, spinal cord injury, and infections of the central nervous system. It describes the causes, signs and symptoms, diagnostic tests, nursing diagnoses, and treatment approaches for each condition. Nursing priorities for patients include maximizing respiratory function, preventing further injury, promoting mobility, preventing complications, and supporting psychological adjustment.
This document provides an overview of brain tumors including their definition, causes, risk factors, classification, symptoms, diagnostic tests, treatment options and nursing management. Some key points:
- A brain tumor is an abnormal cell growth within the brain that can be benign or malignant. Common types include gliomas, meningiomas, and pituitary tumors.
- Risk factors include age, gender, family history, exposure to radiation or chemicals. Symptoms vary based on tumor location but may include headaches, nausea, vision changes, seizures and neurological deficits.
- Diagnosis involves imaging tests like CT/MRI along with biopsy. Treatment options include surgery, radiation, chemotherapy, and supportive care. Nursing focuses on monitoring for increased
Presentation1.pptx, radiological imaging of congenital anomalies of the spine...Abdellah Nazeer
This document discusses congenital anomalies of the spine and spinal cord, focusing on their radiological imaging findings, particularly with MRI. It describes the normal embryological development of the spine and how abnormalities can occur. The most common congenital anomalies are spinal dysraphisms and caudal spinal anomalies. MRI is often used to diagnose these prenatally, at birth, or later in life. Specific spinal dysraphisms are then defined and categorized as open or closed, and examples of each are provided with imaging examples. Chiari malformations are also discussed, with Chiari Type I being the most common and involving herniation of the cerebellar tonsils.
Hydrocephalus , Spina Bifida and craniosynotosis garimabhardwaj31
Craniosynostosis is the premature fusion of skull sutures, restricting skull growth in some areas and enhancing it in others. The main types are:
- Scaphocephaly from sagittal suture fusion, causing a long narrow head.
- Trigonocephaly from metopic suture fusion, pushing the forehead forward in a triangular shape.
- Plagiocephaly from unilateral coronal or lambdoid fusion, causing an asymmetric "skewed" head shape.
- Brachycephaly from bilateral coronal fusion, restricting forward and backward growth for a short wide head.
- Oxycephaly from coronal plus other suture fusion,
USMLE GENERAL EMBRYOLOGY 012 Fourth week development A embryo .pdfAHMED ASHOUR
During the fourth week of embryonic development, neurulation and somite formation are critical processes that contribute to the formation of the nervous system and musculoskeletal structures.
These processes are intricately connected and occur concurrently during the fourth week of embryonic development. Neurulation sets the stage for the formation of the nervous system, while somite formation contributes to the development of the musculoskeletal system.
1. The document discusses the embryogenesis, anatomy, histology, classification and clinical presentation of brain tumors. It describes how brain tumors are classified based on their location, tissue of origin and malignancy grade.
2. The most common types of brain tumors are gliomas such as astrocytomas and ependymomas, as well as meningiomas. Clinical features include headaches, seizures, and signs of increased intracranial pressure. Diagnosis involves imaging such as CT and MRI scans.
3. Treatment options include surgical excision, radiotherapy and chemotherapy, depending on the type and grade of the tumor. The goal of treatment is complete removal of the tumor.
1. The document discusses spinal dysraphisms, which are congenital lesions of the spine. The most common are diverse forms of spinal dysraphism and caudal spinal anomalies.
2. Imaging techniques like radiography, CT, MRI, ultrasound, and nuclear imaging can be used to diagnose spinal dysraphisms prenatally, at birth, in early childhood or adulthood. The causes are multifactorial involving genetic and environmental factors like folic acid deficiency.
3. Spinal dysraphisms can be open like myelocele or myelomeningocele, or occult. Chiari malformations are also discussed, in particular Chiari type I and II which are commonly associated with spinal dysraph
ARNOLD CHIARI MALFORMATION-STRUCTURAL DEFECTS IN BRAIN AND SPINAL CORDManjumam2
Arnold-Chiari malformation is a structural defect where the cerebellum, which controls balance, protrudes through the opening at the base of the skull. There are four types with varying severity, from type I where only the cerebellar tonsils extend through, to type IV with an underdeveloped cerebellum. Common symptoms include headaches, neck pain, dizziness, weakness, and difficulty swallowing. Diagnosis involves medical history, neurological exam, and an MRI to identify the extent of herniation. Treatment depends on the type but may include surgery to repair other issues, shunt placement, decompression, and physiotherapy to help manage symptoms.
Training program from Virginia Blood Services based on their policy and practices as well as patient demographics for the Central Shenandoah Valley in VA. The emphasis of Data on Harrisonburg, VA and Winchester, VA
Training program from Virginia Blood Services based on their policy and practices as well as patient demographics for the Central Shenandoah Valley in VA. The emphasis of Data on Harrisonburg, VA and Winchester, VA
Training program from Virginia Blood Services based on their policy and practices as well as patient demographics for the Central Shenandoah Valley in VA. The emphasis of Data on Harrisonburg, VA and Winchester, VA
Blood type compatibility is important because blood can only be transfused between certain blood types without risking life-threatening emergencies. There are over thirty-five known blood groups but medical focus is typically on the ABO and Rh blood group systems. The ABO blood group is based on possession of A, B, both, or neither antigens and was discovered in 1900; it determines red blood cell and plasma compatibility. The Rh blood group system involves Rh+ or Rh- factors and was discovered in 1937; it further specifies red blood cell compatibility. Understanding a recipient's ABO and Rh blood type is necessary to determine which donor blood types are compatible without risk of transfusion reaction.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler, Verified Chapters 1 - 33, Complete Newest Version Community Health Nursing A Canadian Perspective, 5th Edition by Stamler Community Health Nursing A Canadian Perspective, 5th Edition TEST BANK by Stamler Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Study Guide Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Stuvia Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Studocu Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Test Bank For Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Pdf Download Course Hero Community Health Nursing A Canadian Perspective, 5th Edition Answers Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Ebook Download Course hero Community Health Nursing A Canadian Perspective, 5th Edition Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Studocu Community Health Nursing A Canadian Perspective, 5th Edition Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Chapters Download Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Pdf Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Study Guide Questions and Answers Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Ebook Download Stuvia Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Questions Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Studocu Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Quizlet Community Health Nursing A Canadian Perspective, 5th Edition Test Bank Stuvia
Basavarajeeyam is a Sreshta Sangraha grantha (Compiled book ), written by Neelkanta kotturu Basavaraja Virachita. It contains 25 Prakaranas, First 24 Chapters related to Rogas& 25th to Rasadravyas.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
Adhd Medication Shortage Uk - trinexpharmacy.comreignlana06
The UK is currently facing a Adhd Medication Shortage Uk, which has left many patients and their families grappling with uncertainty and frustration. ADHD, or Attention Deficit Hyperactivity Disorder, is a chronic condition that requires consistent medication to manage effectively. This shortage has highlighted the critical role these medications play in the daily lives of those affected by ADHD. Contact : +1 (747) 209 – 3649 E-mail : sales@trinexpharmacy.com
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
- Video recording of this lecture in English language: https://youtu.be/kqbnxVAZs-0
- Video recording of this lecture in Arabic language: https://youtu.be/SINlygW1Mpc
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Does Over-Masturbation Contribute to Chronic Prostatitis.pptxwalterHu5
In some case, your chronic prostatitis may be related to over-masturbation. Generally, natural medicine Diuretic and Anti-inflammatory Pill can help mee get a cure.
1. WAYNESBORO FIRST AID CREW
2016 DRILL SERIES
Arnold-Chiari Malformation
Material Provided by:
National Institute of Neurological Disorders & Stroke
http://www.ninds.nih.gov/
2. HISTORY OF THIS TR A INING
When I worked for the Manhasset Campus of Northshore-Long Island Jewish Hospital in New
York many of us were trained about Arnold-Chiari Malformation.
Recent studies have shown this to now be as prevalent as 1 in 200 or 300 people (Waynesboro
has a population of 21,000 statistically we could have between 70 to 100 residents with this
ailment).
Knowing about this disease could help us to ask pertinent questions of our patients to aiding the
physicians in catching this “low radar” disease. Meaning some of these people could potentially
get the treatments they so richly need.
They say the only way to understand the illness is to walk a day in the shoes of the patient, with
that mindset I have attempted to include various testimonials to help you to understand what
these patients go through on their path to obtaining this diagnosis for a disease not many know.
-Christopher Bayonet
3. NORTHSHOR E - LONG ISLA ND J EW ISH
THE CHIA R I INSTITUTE
The Chiari Institute is the world's first comprehensive, multidisciplinary
center for the management of patients suffering from Chiari malformation
(CM), a rare structural condition that affects the cerebellum; syringomyelia, a
chronic disease of the spinal cord; and related disorders. Established in 2001
by the North Shore-LIJ Health System, the Chiari Institute is located in a
state-of-the-art facility in Great Neck, N.Y.
The Chiari Institute was founded by Dr. Thomas H. Milhorat, former
Chairman of the Departments of Neurosurgery at North Shore University
Hospital in Manhasset, N.Y., and Long Island Jewish Medical Center in New
Hyde Park, N.Y., and represents the fruition of his decade-long effort to
establish an institution dedicated to the treatment of these often
misdiagnosed conditions.
The Institute is named in honor of Professor Hans Chiari, an Austrian
pathologist who first described abnormalities of the brain at the junction of
the skull and spine more than a century ago. Physician members of The Chiari
Institute include neurosurgeons, neurologists who closely collaborate with
pain management specialists.
The Chiari Institute
611 Northern Boulevard
Suite 150
Great Neck, NY 11021
Phone: 844-56NEURO (844-566-3876)
Fax: (516) 570-4444
E-mail: tci@nshs.edu
5. W HA T A R E CHIA R I MA LFOR MA TIONS?
Chiari malformations (CMs) are structural defects in the cerebellum, the part of the brain that controls
balance. Normally the cerebellum and parts of the brain stem sit in an indented space at the lower rear
of the skull, above the foramen magnum (a funnel-like opening to the spinal canal). When part of the
cerebellum is located below the foramen magnum, it is called a Chiari malformation.
CMs may develop when the bony space is smaller than normal, causing the cerebellum and brain stem to
be pushed downward into the foramen magnum and into the upper spinal canal. The resulting pressure
on the cerebellum and brain stem may affect functions controlled by these areas and block the flow of
cerebrospinal fluid (CSF)— the clear liquid that surrounds and cushions the brain and spinal cord—to
and from the brain.
6. W H A T C AU S E S C H I A R I M A L F O R M A T I O N S
CM has several different causes. It can be caused by structural defects in the brain and spinal cord that
occur during fetal development, whether caused by genetic mutations or lack of proper vitamins or
nutrients in the maternal diet. This is called primary or congenital CM. It can also be caused later in life
if spinal fluid is drained excessively from the lumbar or thoracic areas of the spine either due to injury,
exposure to harmful substances, or infection. This is called acquired or secondary CM. Primary CM is
much more common than secondary CM.
7. A R NOLD - CHIA R I MA LFOR MA TION
TESTIMONIA L I
8. S Y M P TO M S O F C H I A R I M A L F O R M A T I O N
Individuals with CM 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.
Symptoms may change for some individuals, depending on the buildup of CSF and resulting
pressure on the tissues and nerves. Persons with a Type I CM may not have symptoms.
Adolescents and adults who have CM but no symptoms initially may, later in life, develop signs
of the disorder. Infants may have symptoms from any type of CM and may have difficulty
swallowing, irritability when being fed, excessive drooling, a weak cry, gagging or vomiting, arm
weakness, a stiff neck, breathing problems, developmental delays, and an inability to gain weight.
9. CHIA R I MA LFOR MA TION DIA GNOSIS
PA RT I
Many people with CMs have no symptoms and their malformations are discovered only
during the course of diagnosis or treatment for another disorder. The doctor will perform
a physical exam and check the person’s memory, cognition, balance (a function controlled
by the cerebellum), touch, reflexes, sensation, and motor skills (functions controlled by
the spinal cord). The physician may also order one of the following diagnostic tests:
An X-ray uses electromagnetic energy to produce images of bones and certain tissues on
film. An X-ray of the head and neck cannot reveal a CM but can identify bone
abnormalities that are often associated with CM. This safe and painless procedure can be
done in a doctor’s office and takes only a few minutes.
10. CHIA R I MA LFOR MA TION DIA GNOSIS
PA RT II
Computed tomography (also called a CT scan) uses X-rays and a computer to produce two-
dimensional pictures of bone and vascular irregularities, certain brain tumors and cysts, brain
damage from head injury, and other disorders. Scanning takes about 3 to 5 minutes. This painless,
noninvasive procedure is done at an imaging center or hospital on an outpatient basis and can
identify hydrocephalus and bone abnormalities associated with CM.
Magnetic resonance imaging (MRI) is the imaging procedure most often used to diagnose a CM. Like
CT, it is painless and noninvasive and is performed at an imaging center or hospital. MRI uses
radio waves and a powerful magnetic field to produce either a detailed three-dimensional picture
or a two-dimensional “slice” of body structures, including tissues, organs, bones, and nerves.
Depending on the part(s) of the body to be scanned, MRI can take up to an hour to complete.
12. CHIARI MALFORMATION TYPE I
Type I involves the extension of the cerebellar tonsils (the lower part
of the cerebellum) into the foramen magnum, without involving the
brain stem. Normally, only the spinal cord passes through this
opening. Type I—which may not cause symptoms—is the most
common form of CM and is usually first noticed in adolescence or
adulthood, often by accident during an examination for another
condition. Type I is the only type of CM that can be acquired.
13. CHIARI MALFORMATION TYPE II
Type II, also called classic CM, involves the extension of both cerebellar and brain stem
tissue into the foramen magnum. Also, the cerebellar vermis (the nerve tissue that
connects the two halves of the cerebellum) may be only partially complete or absent.
Type II is usually accompanied by a myelomeningocele—a form of spina bifida that
occurs when the spinal canal and backbone do not close before birth, causing the spinal
cord and its protective membrane to protrude through a sac-like opening in the back. A
myelomeningocele usually results in partial or complete paralysis of the area below the
spinal opening. The term Arnold-Chiari malformation (named after two pioneering
researchers) is specific to Type II malformations.
14. CHIARI MALFORMATION TYPE III
Type III is the most serious form of CM. The cerebellum and brain stem protrude,
or herniate, through the foramen magnum and into the spinal cord. Part of the
brain’s fourth ventricle, a cavity that connects with the upper parts of the brain and
circulates CSF, may also protrude through the hole and into the spinal cord. In rare
instances, the herniated cerebellar tissue can enter an occipital encephalocele, a
pouch-like structure that protrudes out of the back of the head or the neck and
contains brain matter. The covering of the brain or spinal cord can also protrude
through an abnormal opening in the back or skull. Type III causes severe
neurological defects.
15. CHIARI MALFORMATION TYPE IV
Type IV involves an incomplete or underdeveloped cerebellum—a condition
known as cerebellar hypoplasia. In this rare form of CM, the cerebellar tonsils
are located in a normal position but parts of the cerebellum are missing, and
portions of the skull and spinal cord may be visible.
16. A R NOLD - CHIA R I MA LFOR MA TION
TESTIMONIA L II
17. OTHER A SSOCIA TED CONDITIONS
Hydrocephalus
Spina Bifida
Syringomyelia (or Hydromyelia)
Tethered cord syndrome
Spinal curvature
18. HY DROCEPHA LUS
An excessive buildup of CSF in the brain. A CM can block the
normal flow of this fluid, resulting in pressure within the head that
can cause mental defects and/or an enlarged or misshapen skull.
Severe hydrocephalus, if left untreated, can be fatal. The disorder can
occur with any type of CM, but is most commonly associated with
Type II.
19. SPINA BIFIDA
The incomplete development of the spinal cord and/or its protective
covering. The bones around the spinal cord don’t form properly,
leaving part of the cord exposed and resulting in partial or complete
paralysis. Individuals with Type II CM usually have a
myelomeningocele, a form of spina bifida in which the bones in the
back and lower spine don’t form properly and extend out of the back
in a sac-like opening.
20. SY R INGOMY ELIA
Also known as hydromyelia, is a disorder in which a CSF-filled tubular
cyst, or syrinx, forms within the spinal cord’s central canal. The
growing syrinx destroys the center of the spinal cord, resulting in
pain, weakness, and stiffness in the back, shoulders, arms, or legs.
Other symptoms may include headaches and a loss of the ability to
feel extremes of hot or cold, especially in the hands. Some individuals
also have severe arm and neck pain.
21. TETHER ED COR D SY NDROME
Occurs when the spinal cord attaches itself to the bony spine. This
progressive disorder causes abnormal stretching of the spinal cord
and can result in permanent damage to the muscles and nerves in the
lower body and legs. Children who have a myelomeningocele have an
increased risk of developing a tethered cord later in life.
22. SPINA L CURVA TUR E
Common among individuals with syringomyelia or CM Type I. Two
types of spinal curvature can occur in conjunction with CMs:
scoliosis, a bending of the spine to the left or right; and kyphosis, a
forward bending of the spine. Spinal curvature is seen most often in
children with CM, whose skeleton has not fully matured.
23. A R NOLD - CHIA R I MA LFOR MA TION
TESTIMONIA L III
24. CHIA R I MA LF OR MA T ION T R EA T MENT S
PA RT I
Some CMs are asymptomatic and do not interfere with a person’s
activities of daily living. In other cases, medications may ease certain
symptoms, such as pain.
Surgery is the only treatment available to correct functional disturbances
or halt the progression of damage to the central nervous system. Most
individuals who have surgery see a reduction in their symptoms and/or
prolonged periods of relative stability. More than one surgery may be
needed to treat the condition.
25. CHIA R I MA LF OR MA T ION T R EA T MENT S
PA RT II
Posterior fossa decompression surgery is performed on adults with CM to
create more space for the cerebellum and to relieve pressure on the spinal
column. Surgery involves making an incision at the back of the head and
removing a small portion of the bottom of the skull (and sometimes part
of the spinal column) to correct the irregular bony structure. The
neurosurgeon may use a procedure called electrocautery to shrink the
cerebellar tonsils. This surgical technique involves destroying tissue with
high-frequency electrical currents.
26. A R NOLD - CHIA R I MA LFOR MA TION
DECOMPR ESSION SURGERY
27. CHIA R I MA LF OR MA T ION T R EA T MENT S
PA RT III
A related procedure, called a spinal laminectomy, involves the surgical removal of
part of the arched, bony roof of the spinal canal (the lamina) to increase the size of
the spinal canal and relieve pressure on the spinal cord and nerve roots.
The surgeon may also make an incision in the dura (the covering of the brain) to
examine the brain and spinal cord. Additional tissue may be added to the dura to
create more space for the flow of CSF.
Infants and children with myelomeningocele may require surgery to reposition the
spinal cord and close the opening in the back.
28. A R NOLD - CHIA R I MA LFOR MA TION
SP INA L LA MINECTOMY
29. CHIA R I MA LF OR MA T ION T R EA T MENT S
PA RT IV
Hydrocephalus may be treated with a shunt system that drains excess fluid and relieves
pressure inside the head. A sturdy tube that is surgically inserted into the head is
connected to a flexible tube that is placed under the skin, where it can drain the excess
fluid into either the chest wall or the abdomen so it can be absorbed by the body. An
alternative surgical treatment to relieve hydrocephalus is third ventriculostomy, a
procedure that improves the flow of CSF. A small perforation is made in the floor of the
third ventricle and the CSF is diverted into the subarachnoid space to relieve pressure.
Similarly, surgeons may open the spinal cord and insert a shunt to drain a syringomyelia
or hydromyelia. A small tube or catheter may be inserted into the syrinx for continued
drainage.
30. A R NOLD - CHIA R I MA LF OR MA T ION
HY DROCEPHA LUS SHUNT SURGERY