Questions posted in the Neurology and Neurosurgery Forum have been answered by doctors from The Cleveland Clinic Foundation.

Question Title: constant pain

Forum: Neurology Forum
Topic: Pain


Dear Sirs,

I am a 39 year old male with a history of cervical fusions at C5/6, C6/7, and C7/T1. I was involved in an automobile accident in May 1998 and have had severe and constant pain every since. I have severe headaches, neck pain, left and right arm pain. I am losing the strength in my left arm, and find it increasingly difficult to grip things. About 4-5 times a day I will experience a sharp, stabbing pain in my right temple. There is tremendous pressure behind my eyes and my head feels like it is ready to explode. Yesterday while I was walking down the hallway at home, I suddenly fell to the ground, feeling like someone had cut my legs out from under me. It is getting increasingly painful to walk.

My neurosurgeon does not think my current pains are disc related. On my last MRI, the radiologist reported a Chiari I malformation. Could these pains be caused by this Chiari thing? My neurosurgeon has referred me to another neurosurgeon because he doesn't believe my current symptoms are disc related and has dismissed any relation to the Chiari malformation. Any assistance you can give will be greatly appreciate.

Thanks for your question. The Arnold-Chiari type I malformation refers to
a downward displacement of the cerebellar tonsils into the upper part of the
cervical canal without associated displacement of the medulla. Because of
the superior imaging that has been available since the advent of the MRI
scan, this type of anomaly has been much more frequently reported as an
incidental finding when the upper cervical region is investigated for other
reasons - in your case, because of the headaches and neck pain. I agree with
your neuro-surgeons that it is less likely that the Chiari is the cause of
your symptoms.

It appears, however, that your symptoms might have at least two separate
causes. The description of your headaches, and the history of recent auto
accident suggests the possibility of post-traumatic headaches. The treatment
usually involves non-narcotic analgesic, non-steroidal anti-inflammatories.

Regarding your neck/arms symptoms, the most worrisome aspect is the apparent
loss of muscle strength. Given your prior surgical history, one should
consider either a spinal canal or a stenosis (narrowing) of the vertebral
spaces where the nerve roots exit the vertebral column. An EMG/NCS study
would be helpful in the evaluation of a possible canal or root lesion.

I hope this information is helpful. Best of luck.

This information is provided for general medical education purposes only.
Please consult your doctor regarding diagnostic and treatment options.

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