Crowding of the posterior fossa pushes the cerebellar tonsils through the opening at the bottom of the skull into the spinal canal.
Headaches worsened by coughing, laughing, straining, or bending; numbness or weakness; balance problems; swallowing or voice changes.
Neurological examination, MRI of the brain and spine, and in some cases a CINE MRI to assess cerebrospinal fluid flow.
Observation with check-ups and serial MRI when symptoms are absent or mild; posterior fossa decompression when symptoms are significant.
What a Chiari malformation is
A Chiari malformation is a condition in which the lower portion of the skull cavity, called the posterior fossa, is crowded. The crowding pushes part of the brain called the cerebellar tonsils down through the opening at the bottom of the skull into the spinal canal.
This can cause pressure on the brain stem and spinal cord and can block the flow of cerebrospinal fluid from the brain to the spine.
Symptoms to watch for
Headaches made worse by certain movements, coughing, laughing, crying, straining, or bending are common. Other symptoms can include:
- Weakness or numbness in the arms or legs
- Balance or gait problems
- Difficulty swallowing or hoarseness of voice
- Ringing in the ears, dizziness, or blurred vision
- Problems with concentration
- Snoring
The majority of Chiari malformations do not cause symptoms and are found incidentally on imaging studies. When symptoms are present, they can be difficult to live with, and they deserve a careful evaluation.
How we evaluate a Chiari malformation
Evaluation begins with a comprehensive neurological examination and appropriate imaging studies, which might include an MRI of your brain and spine.
In some cases we also order a specialized study to look at your cerebrospinal fluid flow at the region of the compression, called a CINE MRI. If we determine that you have a Chiari malformation that is causing symptoms, we discuss treatment options with you based on the severity of your symptoms and the effect they are having on your overall health.
Treatment options
If you do not have any symptoms, or if your symptoms are mild, we may recommend close observation with neurological check-ups and serial MRI scans.
If your condition is more serious, we may offer a surgery called a posterior fossa decompression. This surgery is designed to relieve pressure on your brain by removing a portion of the back of your skull and at times the back of the vertebrae of the upper neck.
When symptoms need urgent attention
New weakness, difficulty walking, trouble swallowing, or a sudden severe headache should not wait for a routine appointment. Call 404-446-4424 for guidance, or seek emergency care for sudden severe symptoms.
This guide is general education and does not replace a personal evaluation. Symptoms, imaging, treatment options, and recovery vary by person.