Can Chiari cause Empty Sella?

[Hawk_About]

I just posted the following in the general neurology section - then I found this forum, and so since it pertains to Arnold Chiari I am reposting it here. Hope it is okay to do so.  Here is the situation:

Can Arnold Chiari cause Empty Sella Syndrome?

I was diagnosed 5 years ago with Arnold Chiari Malformation Type 1.  The symptoms at that time were for the most part attributed to my cervical spine. After nearly a year, things improved and I moved on.

Last summer I began having severe headaches which felt like extreme pressure in my forehead, and sharp pain in my temples.  

An initial MRI in October showed Sella Region was clear.  

A subsequent MRI two months ago in March showed a Pituitary Macroadenoma at 1.4cm.  

A follow up MRI with contrast a month later in April indicated there was no tumor, but there was predominant Cerebral Spinal Fluid intensity within the Sella.  

In between the March MRI which found the Tumor and the April MRI which declared it not there, I began to have brief incidents of double vision along with other symptoms I had been having such as the headaches, and facial numbness.

Surgeon says there was no tumor, that a mistake was made and that what I have is "Empty Sella Syndrome".  I do not fit the profile for the birth defect type as I have never been obese or suffered from high blood pressure.  Although rapid weight gain did occur in the months preceding the headaches, as did a slight elevation in blood pressure.  But this weight is falling off as rapidly as it came on: I have lost twenty two pounds with little to no effort since Febuary. So I have many symptoms I am not going to go into here because I am trying to keep this brief, and I also have many questions as I am in limbo - Neurologist dismissed himself from my case after repeated errors, and I have been referred to a new Neurologist which I am currently waiting to see but it leaves me in limbo without answers. For the most part, to start with, I am questioning now three things:

1.) Did they allow the tumor/cyst to go too long and so it ruptured leaving me with the back up of spinal fluid in my sellla?  How can I know whether or not this happened? Are there clinical signs/indicators?

2.) If there was no tumor and it was just a mistake, could it be the Arnold Chiari malformation that I know for certain I have, that has caused the Empty Sella/Cerebral Spinal Fluid build up?

3.) Can "predominant Cerebral Spinal Fluid intensity" in my now empty sella cause the same mass effect symptoms as a tumor in the Sella?

I could go on in detail about a variety of symptoms, but am trying to keep this brief. I do know that I also have osteoarthritis in my spine, but I don't think this causes Cerebral Spinal Fluid build up in my brain/sella, nor as far as I know it doesn't affect the cranial nerves either. (Facial Numbness and double vision episodes). Other symptoms in general include muscle spasms, tingling and numbness, at times involuntary jerking, and hormonal imbalance symptoms.

Thanks in advance for any insight,

Kat

P.S... Also, both MRI'S from March and April indicate first "Unspecified Periventricular and Subcortical White Matter Changes" (in March when Tumor was diagnosed).  Second MRI in April where tumor was missing states "small foci of periventricular white matter hyperintense T2 signal".  Are these white matter issues significant? At no point did the Neurologist that quit my case ever even mention them.

[selmaS]

Hi Kat....do ask about getting a CINE MRI to check ur CSF flow and ask if u have overcrowding...I don't know if ur dr is a true chiari specialist and could be y u r having a problem getting them to look in the right direction.

If u have a blockage it could explain the excess CSF too......so sorry u seem to be getting the run around.

Please keep us posted...and please feel free to ask or express concerns : )

"selma"

[Hawk_About]

Hi Selma, and thank you.  The neurologist's office I have been referred to called today and scheduled me for the first week in June, so I guess I'll find out then.

I have had headaches for the last 9 months which have been misdiagnosed twice while all the while I have felt all along they are not looking close enough at my Chiari malformation.  The latest report I have on it states that it is "midway to C1", and if memory serves me when they diagnosed it 5 years ago, I *think* it was close to 5mm.

I truly believe it is at the heart of alot of my symptoms.  Some of my pain symptoms are definately related to my spine, but the cranial nerve issues have no explantion yet and the presence of "predominate CSF" in my head tells me it is my Chiari.  But, as you say, the doctor will have to answer that.

Thank you for you kind welcome, I sincerely appreciate it!

Warm regards to all,

~Kat

[selmaS]

HI and welcome to the Chiari forum.

From what I understand ne pituitary issue can cause the Empty Sella....sometimes chiari can cause overcrowding which may put pressure on the pituitary gland.

I have seen Empty Sella mentioned often with chiari.....not sure if it causes it, or else we would all have it......

Did u have the surgery for ur Chiari?

As far as the white matter...there is or should be white matter, u said they noticed a change...not being a dr I am not sure what is meant by this....the only thing I do know is if they meant white lesions, then they could be caused by migraines....

These r very interesting questions and I wish I had the ability to answer....ur dr will have to do that and I hope u come back and let us know what u find out.

We r happy to have u join our little family here, so sorry for the reason u had to seek us out.

"selma"