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Case Studies is a feature designed to highlight interesting patient
cases reported in the research. Given the lack of knowledge about
CM/SM, much of the published research comes in the form of case studies -
doctors describing one or two patients they have seen and treated - as
opposed to rigorous scientific studies. While this type of publication
doesn't advance the scientific cause as much, it does give us a window
into some of the issues surrounding CM/SM, including lasting side effects
and related conditions. And hopefully, some of our readers will say,
"Hey, that's just like me!" and know they are not alone in what they are
going through.
CASE 1: Football, Car Accident & Chiari Reported In:
Poster at the 2003 Technical Meeting of the American Academy of Physical
Medicine and Rehabilitation; published on-line September, 2003.
Doctors: Mary Keen, MD; Steve Gnatz, MD; Marionjoy
Rehabilitation Hospital, Wheaton, Illinois
Patient:
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15 year old male
football player
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Right arm pain
and weakness
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Suffered a right
forearm fracture 1-yr prior in a car accident
-
Physical exam
revealed atrophy of some muscles on the right side
-
Electrodiagnostic
studies were normal
-
An MRI was
ordered to look for herniated disks
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MRI revealed an
11mm Chiari malformation
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Decompression
surgery was performed
-
Patient's
symptoms resolved completely and he returned to playing football
Observations:
Ed Note:
This is an interesting case because it highlights the unknown role
which trauma plays in Chiari. Did the car accident trigger symptoms?
Would he have become symptomatic later in life due to the heavy level of
contact in football? If he weren't in a car accident and never played
football, would he have ever become symptomatic? Also, does trauma
only aggravate symptoms, or can it actually increase the size of the
herniation?
CASE : Carpel Tunnel Symptoms Reported In:
Archive of Physical Medicine and Rehabilitation, January, 2004
Doctors: Mark Ziadeh, MD; James Richardson, MD; Dept. of
Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor
Patient:
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26 year old,
female, administrative assistant
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3 years of
left-hand dysesthesia; symptoms were worse at night and while using a
keyboard
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Patient had been
to a doctor 12 times and had tried splints and gabapentin
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Symptoms
progressed (gabapentin helped a little) over time
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When patient came
to the author's clinic, a careful history revealed that the symptoms had
come on suddenly after she was in bed for 2 weeks with a severe stomach
virus and had thrown up repeatedly
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History also
revealed that symptoms got worse when her neck was bent and that lying down
improved the symptoms
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Doctors suspected
a nerve problem and ordered an MRI
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MRI revealed a
Chiari malformation and a large syrinx extending from C2-T10
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Decompression
surgery improved her symptoms, but they did not go away completely
Observations:
-
Carpal Tunnel
Syndrome (CTS) is the most common diagnosis for hand numbness, however
definitive CTS diagnosis is difficult
-
CTS symptoms can
mask other nerve problems, including syringomyelia
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Sudden onset of
symptoms was not typical of CTS
-
Worsening
symptoms with neck position was not typical of CTS, but did suggest a
problem with the nerves in the neck
Ed Note:
This case highlights a number of the more troubling aspects of
syringomyelia. The patient had been to doctors numerous times over a
period of more than 3 years before being accurately diagnosed.
Unfortunately, this - going years before diagnosis - is all too common.
The sudden onset of symptoms after repeated vomiting also shows how
straining can profoundly effect people with Chiari and syringomyelia.
Back to Table of Contents |
atrophy - wasting away, possibly due to nerve damage
Carpal Tunnel Syndrome - condition where a nerve, which passes
through a tunnel like structure in the wrist, becomes compressed and causes
hand numbness, pain, and weakness
cerebellar tonsils - portion of the cerebellum located at the bottom,
so named because of their shape
cerebellum - part of the brain located at the bottom of the skull,
near the opening to the spinal area; important for muscle control, movement,
and balance
cervical - the upper part of the spine; the neck area Chiari malformation -
condition where the cerebellar tonsils are displaced out of the skull
area into the spinal area, causing compression of brain tissue and
disruption of CSF flow
dysesthesia - an unpleasant, abnormal sensation
electodiagnostics - group of tests which use low levels of
electricity to determine if nerves are functioning properly
syringomyelia (SM) - neurological condition where a fluid filled cyst
forms in the spinal cord
syrinx - fluid filled cyst in the spinal cord
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