Posted by CCF NEUROSURGERY MD on October 06, 1997 at 11:47:28:

In Reply to: friend that has problems posted by Marcia Wright on September 28, 1997 at 22:16:36:

: A co-worker has some neurological problems, and seems not to be able to get any clear cut answers from her current neuologist.
Her history/dx include a syringomyelia, and Arnold Chiari malformation. Currently, she is having blurred vision at times, weakness with intermittant numbness in her arms and legs, "electrical shock" sensations in various parts of her body, increasingly severe headaches, partial hearing loss intermittantly, dizziness, some problems swallowing, her tongue feels like it is thick with slurred speech at times.
In Jan.1996, she had an anterior cervical discectomy on the 5th and 6th level, with a donor bone fusion. After the surgery, she has had a feeling of constant pressure on the left side chest wall, yet has clear chest x-rays. There is also contant pressure in the stomach area on the left side, as well as pain in the left shoulder blade.
At present, she can get no answers for the pressure/ pain feelings that have been ever present since the surgery. Also, no explanation for the other feelings that are really beginning to interfere in her life. There is not a day that she is not in pain, and it is very hard to watch her lifestyle be changed. There are no surgical plans at present, nor other treatment plans. The neurosurgeon offers no explanations, nor answers about her symptoms, and says just to watch things, and see what happens. When directly asked as to prognosis, or what she can expect in the future, there are no responses. Can you shed any light???
Thank you for your time and response.
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Dear Marcia,

Your story speaks to three separate problems in your friend. First is the
cervical disc at C5-6. This type of disc would usually present with pain,
numbness or weakness in the region of the deltoid muscle on the affected side.
Surgery is usually quite effective at alleviating the pain, while the
numbness and weakness may take a while to resolve.

Second is the Chiari malformation, which is often associated with a syrinx
in the spinal cord. They can, however, present differently. A Chiari
malformation is basically the herniation of the cerebellar tonsils out the
foramen magnum. In simple terms, tissue from the posterior aspect of the
brain pushes abnormally out the opening where the spinal cord exits the
cranial vault. This process may produce headaches, dizziness and difficulty
with balance. It may be alleviated by removing the surrounding bone in the
back of the head, known as a suboccipital decompression.

The syrinx, again often associated with a Chiari malformation, presents yet
another issue. Depending on the size, they may cause numbness and weakness
preferentially in the arms over the legs. A decompression procedure for
the Chiari malformation may suffice to relieve symptoms from an associated
syrinx. If not, a shunting procedure may be considered.

Whether any of these is an active issue in your friend should be discussed
with the involved neurosurgeon. A detailled history and physical examination
should shed some light on the issue. As always, you should seek an explanation
which you understand. If the physician's answers are unsatisfactory, a
second opinion may be wise.

Good luck.