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Receiving a diagnosis for an unknown condition like Arnold Chiari Malformation might feel like being in a puzzling game. We know it’s tough to make sense of it all. But don’t worry, you are not alone. In this article, we will explore what Arnold Chiari malformation is all about and how you can manage it. A Singapore Chiropractor explains!
What is Arnold Chiari Malformation?
Arnold Chiari malformation, also known as Chiari malformation, is a structural disease that affects your spinal cord and brain. It causes the lower part of your brain to extend down into the spinal canal.
Normally, the cerebellum (brain part) and a part of the brain stem are located at the base of the skull and above an opening called foramen magnum. This is the opening where the spinal cord connects the brain stem.
Chiari Malformation develops because of the smaller-than-usual-sized skull. Due to insufficient space, the cerebellum is pushed downwards into the spinal cord. It blocks the flow of cerebrospinal fluid (CSF), which is responsible for the supply of nutrients and the removal of waste material from the CNS. CSF also cushions the brain and spinal cord and protects them from injury.
Additionally, changes in the anatomy of the cerebellum can cause symptoms to develop. The cerebellum is a part of your brain that is responsible for muscle movement, coordination, speech, posture, and balance.
Causes of Arnold Chiari Malformation
A structural growth abnormality, especially during fetal development, causes your cerebellum to grow in an abnormal location. Some experts believe that the unusually small posterior fossa, a space where the cerebellum sits, might contribute to the Arnold Chiari malformation syndrome.
It is a congenital disorder that is usually present at the time of birth. You are likely to get it through the genes inherited from your biological parents. It can also develop after conception as a result of exposure to harmful substances.
Rarely, you might get the condition later in life. Anything that takes up space in the skull can result in the development of this disorder. It may include:
- Tumors
- Cysts
- Intracranial hypertension
- Hydrocephalus
- Hematoma
Furthermore, growth anomalies that affect the upper cervical portion of the spine can lead to Chiari malformation. A particular example of this scenario is basilar invagination, where the upper vertebrae block the foramen magnum, thus restricting CSF flow.
Other things that may lead to the development of this disease include:
- Prolonged use of lumboperitoneal shunt to treat hydrocephalus
- Tethered cord syndrome
- Goldenhar syndrome
- Hajdu-Cheney syndrome
- Ehlers-Danlos syndrome
- Achondroplasia
- Albright hereditary osteodystrophy
Symptoms of Arnold Chiari Malformation
Symptoms of Arnold Chiari malformation disease vary from individual to individual. Some people may remain asymptomatic throughout their life and their condition might be diagnosed accidentally. Others may have serious manifestations.
The symptoms generally reflect dysfunction of the spinal cord, brainstem, or cerebellum. These may include:
- Headaches that radiate to cause pain in the neck and shoulder
- Sensitivity to light
- Blurred vision
- Nystagmus (involuntary movement of the eyes)
- Diplopia (double vision)
- Vertigo
- Tinnitus
- Difficulty swallowing the food
- Hearing impairment
- Poor coordination
- Muscle weakness
- Sleep apnea (difficulty breathing while sleeping)
- Fatigue
- Palpitations
- Fainting episodes
- Tingling or burning sensation in the fingers or toes
- Syringomyelia (development of fluid-filled cavity or cyst in the spinal cord, known as syrinx)
- Loss of bladder control
- Curved spine (scoliosis)
Kindly note that you may not have all of the symptoms mentioned above, and they might get better or worse over time.
Arnold Chiari Malformation Types
Chiari malformation is classified into five types that include:
Arnold Chiari Malformation Type 0
Type 0 is a rare form of Chiari malformation. In this type, little to no parts of the cerebellum extend down to the hole at the base of the skull, but there is a little crowding here.
The symptoms might occur due to the blockage of CSF flow. People with this condition develop syringomyelia and headache.
Arnold Chiari Malformation Type 1
Type 1 is the most common form of Chiari malformation. In this type, the lower part of your cerebellum extends down to the spinal canal. It might not get diagnosed till adulthood. It is the most common cause of syringomyelia.
Arnold Chiari Malformation Type 2
The symptoms of type 2 began to develop during childhood. It is generally more severe than type 1. It usually involves the protrusion of both the brainstem and cerebellum into the foramen magnum. It is usually diagnosed during pregnancy or after birth.
Arnold Chiari syndrome type 2 can cause complications, such as hydrocephalus and myelomeningocele. Hydrocephalus is a medical condition where the buildup of CSF within brain ventricles exerts pressure on your surrounding brain tissues. Myelomeningocele occurs when the neural tube that forms the spinal cord and other structures doesn’t close properly during fetal development.
Arnold Chiari Malformation Type 3
Type 3 is very rare and is usually more severe than types 1 and 2. It occurs when part of your cerebellum, brain stem, and meninges extend downwards to the foramen magnum. It can cause life-threatening complications and the condition called encephalocele (swelling at the back of the skull).
Arnold Chiari Malformation Type 4
It occurs due to the underdevelopment of the cerebellum. It is the most intense form of Chiari malformation and carries the risk of fatality during infancy.
Risk Factors for Arnold Chiari Malformation
Chiari malformation can affect anyone at any age. Stats show that it occurs in less than 1 out of 1000 births. Furthermore, the National Institute of Neurological Diseases and Stroke found that women are more likely to suffer from Chiari malformation.
Additionally, type 2 Arnold Chiari malformation is more prevalent in people of Celtic descent. There are some conditions that may predispose you to the risk of disease. These may include:
- Hydrocephalus
- Spina bifida
- Tethered cord syndrome
- Nutritional deficiencies in maternal diet
- Exposure to harmful substances during fetal development
- A family history of Chiari malformation
Arnold Chiari Malformation Diagnosis
Chiari malformation is usually diagnosed when a baby is in the mother’s womb during ultrasound. Otherwise, your doctor may diagnose the condition later in life when you are being tested for other conditions.
The tests that help confirm the diagnosis of Chiari malformations include:
● Magnetic Resonance Imaging
This test will help your healthcare provider find the abnormalities in your brain and spinal cord. It can assess the obstruction in the CSF flow and will help your physician determine the extent of protrusion of the cerebellum into the foramen magnum.
● X-ray
Your doctor might order X-rays to check for any abnormalities in the bones of your skull and neck.
● CT scan
This will help your health provider detect congenital bone abnormalities at the base of your skull.
Furthermore, your doctor can take your complete physical history. He might assess your balance and coordination, sensation in your limbs, and learning speed. Additionally, he may look for developmental delays and memory problems in children. He can also order other tests to detect complications associated with other conditions.
Arnold Chiari Malformation Treatment
Your treatment will be based on the apparent symptoms you have. You might not need any treatment if you have no symptoms. But, your healthcare provider will regularly assess your disease through MRIs.
For mild symptoms, your physician might recommend painkillers and physical therapy. Additionally, he will advise you to avoid lifting heavy weights and use devices for hearing or visual loss.
In severe cases where the symptoms may interfere with your life, your doctor might recommend surgery. The procedure might differ for children and adults and may include:
● Posterior Fossa Decompression
In this procedure, your surgeon will remove a piece of bone from the back of your skull to create room in the foramen magnum. This reduces pressure and allows the cerebellar tonsils to move back to their original position. It is the most common surgery for Chiari malformation.
● Duraplasty
This is a decompression procedure where your surgeon opens the outer membrane that surrounds the brain and spinal cord. Then, a patch (artificial material or tissue from another body part) will be sewn in place to enlarge the membrane which will make more room for the brain. Consequently, it relieves pressure on the brain.
● Laminectomy
In this procedure, your surgeon may remove a small piece of bone that covers the spinal column. It makes room for the spinal cord and allows the CSF to flow properly.
● Electrocautery
Electrical current is applied in this procedure to shrink cerebellar tonsils, causing tonsilar tissue to retract. Most neurosurgeons don’t recommend this invasive surgery, but some patients might require it based on the severity of their condition.
● Shunt Placement
If you have a condition with hydrocephalus, your doctor might implant a tube (shunt) in your skull. It drains excessive CSF away from the CNS to the other parts of the body where it is absorbed. This procedure relieves pressure and might improve symptoms.
Outlook for Arnold Chiari Malformation
Studies show that it usually takes 6 to 8 days to recover from Arnold Chiari malformation surgery. Response to surgical treatment varies from individual to individual.
Some symptoms are likely to improve after surgery while others usually persist. One study found that 96% of people with Chiari malformation type 1 reported improvement in their symptoms. Another study found that there is a 90% chance of long-term stabilization in people with Chiari malformation related-syringomyelia.
How Singapore Chiropractic Care Can Help Arnold Chiari Malformation?
Chiropractic in Singapore is one of the most effective non-surgical procedures to manage symptoms of Chiari malformation. It is focused on correcting misalignment in the vertebrae (C1 and C2) in the neck region.
This creates room for structures like the cerebellum, brain stem and spinal cord. Additionally, it allows CSF to circulate properly, which helps ease the symptoms like headache and dizziness.
Our experts at Vitality Chiropractic Singapore specialize in upper cervical Chiropractic care. They make precise corrections to the bones in the upper neck (C1 and C2) to achieve a balanced alignment of the head and neck. So what are you waiting for?
Contact us right now to restore your balance.
Meet Our Chiari Malformation Specialists
Dr Shaan (Traditional and Complimentary Therapy Qualification) is a Chiropractor from London (UK) who graduated from the Anglo-European College of Chiropractic (UK) as a Doctor of Chiropractic (not medical doctor or dentist). He has completed post-graduate studies and has been serving patients in Singapore since 2015.
He founded Vitality Chiropractic Centres to open the first Upper Cervical clinic in Singapore, and the only practicing Knee Chest Upper Cervical Technique in South East Asia.
He is the Alliance of Chiropractic (AoC) Chairman for Outreach, organising events within Singapore with the People’s Association and other charities. Shaan has served thousands of patients, with experience in patients with headaches, migraines, vertigo, Meniere’s, trigeminal neuralgia, whiplash, IBS and other chronic nervous system problems.
Dr Jessey (黄钰心矫正师) (Traditional and Complimentary Therapy Qualification) is a Chiropractor from Kuala Lumpur (Malaysia), graduated from Anglo-European College of Chiropractic (UK) as a Doctor of Chiropractic (not medical doctor or dentist). She has experience serving patients from 2 weeks old to 96 years old prior to moving to Singapore and joining Vitality Chiropractic (活力脊椎矫正中心).
She has completed post-graduate studies and is Singapore’s first female Upper Cervical Chiropractor (上颈椎矫正护理).
Jessey is active in outreach, participating in charitable trips to Cambodia and within Singapore. Jessey has experience helping patients with headaches, migraines, dizziness (眩晕/头晕), Meniere’s (美尼尔氏综合症), slipped disc, anxiety, fibrillations, IBS and other chronic nerve system problems. She also has a special interest in children and younger patients.
If you’ve been struggling with Chiari Malformation, call 8438 9550, email help@vitalitychiropracticcentres.com or fill in your information below to book your appointment.
Chiari Malformation Chiropractic Rates
Here are the expected rates for Chiari Malformation care services at Vitality Chiropractic centres.
Discovery Call
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Jump on a call to discuss your concerns and determine if we are the right fit for you.
Consultation
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During the initial consultation, we will run a physical examination, postural assessment, and nerve system test.
Test Results
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Our chiropractor will explain the findings and test results from the consultation. A customised care plan will then be developed for you.
Single Session
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We will perform a nerve scan and adjustment as needed. Re-examinations and rehab exercises might be implemented.
Chiropractic Research in Singapore
Read our published case reports about our patient cases and the improvements seen with our care. This was produced by the Australian Spinal Research Foundation, and published in the Asia-Pacific Chiropractic Journal.
REFERENCES
- Aghakhani, N., Parker, F., David, P., Morar, S., Lacroix, C., Benoudiba, F., & Tadié, M. (2009). LONG-TERM FOLLOW-UP OF CHIARI-RELATED SYRINGOMYELIA IN ADULTS. Neurosurgery, 64(2), 308–315. https://doi.org/10.1227/01.neu.0000336768.95044.80
- Albert, G. W., Menezes, A. H., Hansen, D. R., Greenlee, J. D., & Weinstein, S. L. (2010). Chiari malformation Type I in children younger than age 6 years: presentation and surgical outcome. Journal of Neurosurgery, 5(6), 554–561. https://doi.org/10.3171/2010.3.peds09489
- Chiari malformations. (n.d.). National Institute of Neurological Disorders and Stroke. https://www.ninds.nih.gov/health-information/disorders/chiari-malformations
- Hidalgo JA, Tork CA, Varacallo M. Arnold-Chiari Malformation. [Updated 2023 Sep 4]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2023 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK431076/
- Website, N. (2023, July 11). Chiari malformation. nhs.uk. https://www.nhs.uk/conditions/chiari-malformation/#:~:text=A%20Chiari%20malformation%2C%20previously%20called,I%2C%20is%20the%20most%20common.
- Wetjen, N. M., Heiss, J. D., & Oldfield, E. H. (2008). Time course of syringomyelia resolution following decompression of Chiari malformation Type I. Journal of Neurosurgery, 1(2), 118–123. https://doi.org/10.3171/ped/2008/1/2/118
Written by
Shaan Rai (Chiropractor, Singapore)
Shaan is a British Chiropractor, based in Singapore. He is an Alliance of Chiropractic (AOC) registered Singapore Chiropractor, completing a 5 year course at AECC (UK), attaining his Masters in Chiropractic. He is the Vice President and Chairman for Outreach & Charity for Alliance of Chiropractic (AOC) and is the founder of Vitality Chiropractic Singapore. He developed the NeuroPro method, combining Upper Cervical techniques with Functional Neurology Rehab, with published research coming in 2025.
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