Hello. I was diagnosed with Chiari Malformation with tonsils 5mm below the foramen magnum. I was wondering what type of treatment should be considered. I have been suffering with painful numbness and tingling, really bad headaches and bad neck pain/pain in back of head for a long time. I was told that the herniation can be worse upon standing and I had my MRI laying down. Would this make any difference? This is really debilatating and nothing seems to help. I don't know what to do.
Should I consider surgery as an option? thanks.
first u need a chiari specialist...where do u live.....?.....there are sites on line that have alot of info...the chiari institute and ASAP d o t o r g ......ther r lists out there but not all the NS r experts.
...did u also have a CINE MRI?...this is a flow study to check for a blockage of spinal fluid.....u also want to know if u have syringomyelia and a syrinx. My herniation is 6mm and I am waiting for my CINE MRI to be scheduled...I have been in contact with the chiari inst. in NY.....
There r plenty here with surgery and those that have not had it yet.
Thank you for your response. I live in Dallas, Tx, but I am willing to go to a good doctor, even if out of state. I have not had a CINE MRI. Is that like a cspine mri? Sorry, I am new to all this. My main concern is just that this will get worse. I work retail and am on my feet ALL day and carry things. I have heard two different things. I have heard it CAN'T get worse and I have also been told that it most likely WILL get worse. I just don't know what to think.
I had a spinal tap a month ago and they discovered that I had increased pressure in the brain (only 22 - normal is 18). I have read that increased pressure in the brain can be from a blockage of spinal fluid. What do you think?
I think I need to check into getting that CINE MRI. Thanks so much. I appreciate any advice that you have.
A CINE MRI u would have a clip on ur finger...it is to watch the spinal fluid as the heart beats...to see if there's a blockage....TX...I just was talking to someone down there...if u can get to CO...Dr. Oro is one of the best out there!!
if u go to my profile page...in my journal...read the poem that a dr wrote....to know there r drs that understand that well just helps me get thru.....
different things can cause ur chairi to degenerate faster....stress, trauma to head or neck...age....or unknown, since u had it from birth , u should look back to see when u started showing symptoms....how long have they been "bad"......one person's herniation was 5 mm and in less then 5 monthes was 10mm...which needed susrgery.....as these herniations grow the possibility of perminate damage grows as well.
try the ASAP d o t o r g site......there is alot of info as well as contact info for drs.
You need to find a chiari specialist - most doctors have never even heard of this and most neuologists want to try medication or therapy. In my opionion; these things don't help much. They can slow the onset somewhwt for a time, but surgery is the best option - again, this is my opinion.
Find a neurosurgeon that is considered a chiari expert - if you could make it to Colorado, see Dr Oro. Check around online. I also seem to recall there's others on this site that are from Texas (not that they necessarily are anywhere near you :)).
I'm not trying to scare you, the tingling and pains in your back are suggestive of syringomyelia. That suggests the herniation is starting to effect the flow of spinal fluid, which can lead to paralysis.
Chiari is not normally considered life-threatening, but it is life-changing. Don't waste time on getting on top of this. This is congenital so you've actually had it all your life, but it's only starting to get bad enough to notice. It could take years for it to get much worse, or it could happen very quickly. I was first diagnosed with mine 6 months ago, but it was 20mm and I had to have surgery immediatly. Another person on these threads had a 5mm herniation 2 months ago and when the Doctor operated a week ago, it had increased to 10mm.
Make sure you find a good neurosurgeon and get MRI's as soon as possible. If you disagree with the doctors or they tell you that Chiari isn't a big deal - get a second (or 3rd or 4th) opinion.
Oh Boy - I am in Australia however I am finding all this conversation very helpful and will now have a list of questions for after my MRI and when I see the specialist. I know he is not a "chiari specialist" but I dont even know if we have these in Australia. Do people die from this?
I agree with Shane99 and SelmaS basically about being an advocate for your own health. I am the one they were referring to that had the 5mm herniation that grew to a 10mm upon surgery. I had surgery 2 weeks ago and the herniation had doubled. My symptoms had progressively gotten worse, and honestly by the surgery date- I didn't think I could continue to function much longer. I am so thankful that God placed in my path knowledgable people on this forum that pointed me to a knowledgable doctor. Like I said- I am two weeks post operation and I feel better than I've felt in a year. I had really started to deteoriate! The majority of my symptoms are gone! Of course I still have some head pain- but I just had 29 staples removed from my head on Monday. So- I would suspect that I will have some head pain for a little while. But, it's a different head pain- it's not the same as before surgery!
I am a huge advocate of the surgery if you find a great Chiari specialist! All I can do is share my story- I feel TONS better than I did before the surgery! God is GOOD!!!
Thanks for everyones help. I have sent my films to Dr. Oro in Colorado. They should receive them tomorrow at 10:30 a.m. I hope to hear something back next week regarding an appointment. He wants to look at the films first and then schedule the appointment. I am very hopeful with this doctor. He can't get me in until January, but I will take it. I am just glad to have some hope because I am miserable and nothing helps. I have had so many docs look at me like I am crazy. My primary care doc is so great and supportive in helping me to get better, but all the other doctors I have seen look at me like they have no clue. I have just been referred out to ANOTHER neurologist because the one I am seeing now doesn't know what to do with me basically. He does not believe in the surgery and that is fine, he does not have to. He does not think it really helps. ( He has only had 2 other patients with Chiari and I am his 3rd....so I don't feel he has an educated opinion on the subject.) I believe in treatment and that it will help and thats all that matters to me. I have just learned that I can't lose hope.
If you don't mind me asking...how does the Chiari make everyone else feel?
Like I have terrible pain in the back of my head, neck and upper back, numbness, tingling, and the list goes on and on. I was just curious if anyone wants to share.
Thanks. The websites helped a lot too, so thanks for that also.
Hi LG! I am still working on my diagnosis, but these are my symptoms: extreme pain in my neck, shoulders and arms. Daily headaches. Coldness, numbness & tingling in my hands, feet and face. Scoliocis. Ringing in my right ear. Stumbling when I walk. Blurred vision in right eye. Slurred speech, forgotten words. Choking. A really weird one - I don't sweat - ever, for any reason. Not sure if it's connected but hey - why not throw it in for good measure? LOL! So, That's some of mine. The worse are the daily migraines and the constant pain. I can deal with the rest, buy it would sure be nice to get some relief from those!
....I am glad u trew in the no sweating for good measure....I have said for years...I don't sweat....never minded the heat ever.!!...But lately I have been having cold sweats...not sure but think that is related to my hashimoto's dx.
I 'd also like to invite u to view my profile pg to see a poem by Dr Oro....it's in my journal.
it is so comforting to know that there r drs out there that understand.
U were asking how we feel /symptoms of chiari:
I get severe headaches....worse with straining...coughing....laughing which causes me to cough, choke and gag...sometimes to vomit......gait problems ....balance issues....blurred vision....vertigo......hand tremors....jaw and facial pain...ear pain, like an ice pick jabbing in my ear....swallow issues.....heart palps....anxiety comes on suddenly and leaves just as sudden almost like butterflies in the stomach, but not....and falls.....bump into everything......trouble sleeping....always tired....
My MRI came back that I had this malformation but they said it is only slight. I have been in pain for a year now and if I dont get this fixed I will loose my job, my family, etc. Is there anything you can do to help until your drs figure it out? I have dr.s that dont want to help or dont believe me as they say everything is fine and they cant find anything else. I cannot take the pain anylonger. I am getting referred to a neurosurgeon but they said it could take awhile. How can I get help right away? How can I get to someone that will help me if my dr. wont refer me or rush this?
Hi,unfortunatly most drs and NS's are not educated on chiari and follow old ideas regarding them...I also have mild chiari....6 mm herniation and am very symptomactic...do u know ur herniation? The other issue concerning chiari is a relativly new term called chiari 0...with this form there is no herniation.....chiari specialists will look not only at the herniation, but also at symptoms and CSF flow!
Do u have a copy of ur report and the MRI disk?...if not request one and continue to do so going forward.
If u do have ur report, u could give more info from it....please check our thread on chiari specialists...most here r listing their drs on the list....please research all drs on the list, not all r necessarily chiari experts.It is not to be considered reccommendations just a place to start.
I hope u continue to post here, it's a great place for support!!
Hi - I also have a "slight" case of Chiari. My herniation is only 2-3 mm, but I have very severe symptoms. My CSF flow appears to be good, but I am still in agony everyday. I understand this. So far, the only dr. to really help me is my GP, who gives me my pain meds with no lectures. I just went to a NS, who - of course said because it was slight it wasn't really causing my symptoms. He told me to go to a phychiatrist and then join the Peace corp and all of my problems would disappear..... uh huh... I really empathize with you!
I do not know my herniation. The dr.s just pass it off and like you say, say it isn't that it is muscle spasms in my neck. I am going to a specialists on Dec. 22 here in Des Moines Iowa though. I just had 8 steroid shots in my head and neck on Tuesday. I just dont know what to do. I am trying to do anything to relieve this pain. My husband got me a neck brace tonight to see if that would help as I cant be gone from work anymore. I cannot miss another day. How do you get to the right drs though. I have to be referred most anywhere and it seems like no one can help or suggest the right treatments. I have taken almost every medicine there is and they dont work either. I just cannot take this pain anymore and need to fix it now. But no one will help me.
HI....make sure u ask for copies of all ur MRI's and the reports!
U need to educate ur PC dr on what chiari is.This will help him/her understand the need for u to be seen by a chiari specialist. Most of us do need to travel to get to one.
I believe I may have mentioned Dr. Arnold Menezes Univ of Iowa, Iowa City, IA
he is a chiari specialist. Please check him out, research on the web.We also have a thread here called chiari specialists list....u may find a name there u may want to research as well.
I am not sure the neck brace will help...it depends on ur herniation and the size of the neck brace....
Make sure u have MRI's of ur brain w/wo contrast...of ur cervical spine, thoracic and lombar spine. Ur dr should be looking for is a CSF flow blockage and a syrinx.Then he/she should look at ur symptoms and ur herniation.
There is no cure for chiari.only treatments.it can get worse rather quickly too!
I understand ur feeling like noone is helping, but it's more like they don't know what to do...learn as much as u can....and find a chiari specialist u r comfortable with!
I've posted on some other chiari forums-doctors seem to give you the"brush off" like Selma told me once. It feels as if you're suffocating because only you and all of us here know what this pain feels like...and EVERYTHING else. I feel everything you do Selma. It's unbelievable that these doctors don't know so they look at you as if you're crazy BUT we are blessed to have people here who can share their knowledge and guide is in the right direction. Hang in there. We know how you feel. Remember that God gave doctors their knowledge and if they can't do anything...you know there is a God up in heaven who will make a way for you. =-)
I too am from australia. I have a 5mm herniation..and im so bad at the moment i hardly get out of bed. Two days ago I checked myself out of hospital, the day i checked out I was meant to have a lumberpuncture just before this my NS came in and told me to stay on my meds and loose more weight??? what the...im 5ft 10 and weigh 90kgs dont see that as overweight, the thing is I have lost weight and havent got any better, he seems to think loosing weight is the cure for everything. I got diagnosed last DEC and since then have gone down hill, Very unbalanced,dizzy,sore neck/shoulders all the time. Uncontrolled moods. cant sleep but fatigued all the time,cant travel long distance. forget things all the time, and really just in pain 24/7 im to the stage where I think god I cant live like this anymore. Anyway so I thought why should i have LP when im not going to benefit from it. I was going to see a neurosurgeon whilst in hospital but being 4 hours from home and my family n kids I though I will just go home and wait to see someone and besides my NS had really gotten up nose with his advice for me. Now back to square one. I think i need to change NS and find a specialist in chiari within australia. Every nurse and student that came in my room would sit down and ask me to educate them on chiari, gee makes ya feel really safe, and they do brush you off like its all in my head. I had a CT done and I know a CT is not going to show the same as a MRI why didnt they put me in for a MRI man i could go on forever, im frustrated, confused and angry and want my life back. Where to from here????
Oh and also I cannot exercise now either because eveytime i get even a slight raised heartrate i end up in bed with a huge migraine for two days. So this is why i refused to have Lumberpuncture because after being told to just go home ake meds and loose more weight, i wasnt going to go through the pain of having a week long aching stabbing migraine that follows, and chiari people are 10 times worse than anyone else after having these.
I know this is not easy, but you need to find a NS who specializes in Chiari. I am still searching myself as my dx was just made 5 wks ago. I have a PCP & have seen a NS who both are "passing the buck" back to a NL who feels I shouldn't be concerned & that my symptoms are not Chiari related. I have many of the 'classic' Chiari symptoms (with 10mm extension) & the NL ruled out MS 3 yrs ago, so I don't understand his attitude. He has me on Lyrica for the nerve pain, but no one has done anything else for my other symptoms. My husband told the NS he is worried about my tunnel vision & my driving & the NS just walked away. I copped an attitude w/the NS & asked him if I should wear a helmut to work so if I actually fell during one of my dizzy spells or when I'm off balance I wouldn't hurt myself & he just shrugged his shoulders. None of my med professionals want to deal w/my symptoms!!! I wish if they don't know enough about Chiari they would just admit it & I'll move on. Please try & locate a specialist so you can get the help you need. Good luck with your hunt & keep us posted. ***Jean
I know. I spoze at the end of the day i am a big chicken with getting and LP after my last experience it has really frightened the **** out of me. And the fact that NO one knew about chiari at all just blew me away. Im going to hunt around for a new NS my one is very old fashioned and stuck in his ways, and loosing weight cures everything, im sorry sunshine maybe sometimes but not in this case!! And whats worse is another NS came to see me in hospital whom was going to do the LP on me, she said straight up to me, toni I had no notes on you couldnt get hold of your NS and lucky you told me about your condition and I ordered CT (not that that showed anything) to see for myself she said, I would have gone ahead and done normal LP on you and may have ended up life threatening. So I like her but once again she dosnt know anything about chiari and relyed on everything I told her. I told them I wasnt a guinea pig lol. And that I dont feel safe I would rather go home. So from here I will see how I get on witnh the neuro surgeon and see what he has to say. At least she told me I was rare and complicated well i didnt need a diagnosis for that one ha ha. :)
It's almost 3:30 AM where I'm at, what time is it on your side of the world? Yes, being up this late is one of my Chiari issues...I'm either falling asleep at the most improper times or I can't sleep at all.
I am so glad you didn't have the LP...some of the research I have done says that spinal taps of any type can be very harmful to Chiari patients (oops, I almost said 'victims' because that's the way I feel some days).
It seems as though the dr's we like & are comfortable with end by not being knowledgeable enough about Chiari. And then because not enough dr's are experienced with Chiari, we end up w/dr's who have terrible bedside manners or are unapproachable (like the NS I saw earlier this wk). We need to be dealt with as a whole person, not just a mis-shapened skull w/our brains slipping out. Our symptoms effect our whole being, our lives & even those around us. Come on doc's get with the program!!!
If you already know you have a 5mm herniation, then I would suggest the MRI you ask for be a CINE-MRI, so the CSF flow can be looked at too. If the CSF is compromised enough it may make the next step easier for your dr & you to make.
There was a time when I thought that "being rare" was a good thing (my hubby & I collect antiques), but I'm not so sure anymore. LOL
The best advice I've gotten has been from these wonderful people here so continue to hang with us!! It was the same advice I got from my optomologist..."be your own advocate." ***Jean
thanks for this would be good to be able to track hursty down and find out what info she is able to give me, feel like i have a huge battle on my hands. I dont know if they have CINEMRI but i sure would like to find out as the last experience i had with my last LP was terrifying I thought my head was going to fly off...lol.
If u use the seaarch this community feature and type in Hursty48 u will get threads with her name....click on her name and it will take u to her profile page...u can send her a private message (PM) or a note.....her first name is Sue.
I was diagnosed in 09 with a 7mm herniation after a MVA. Now for quit sometime I have had medical issue's, especially after I have had my 2 children. But within the last couple of years I have had:
Dizziness/vertigo/feeling like I am swaying at times
My hands tremor
Hands and feet tingle
Ringing in ears/hearing loss/sensitivity to loud noise's
weakness in hands( to the point where I have can't really open jars anymore)
Stabbing feeling in my ear, sometimes at back of my head (to the point that I drop what I am doing because of the pain)
Fatigue/problems falling asleep
Now about 2-5 yrs ago they diagnosed me with Menieres Diease, and IBS.
After my MVA all the Neurologist's said that none of my problems was with the CM. So I just stopped going, all they wanted to do was put me on pain pills and muscle relaxer's. But this last year has gotten pretty bad with all these symptoms. It's very hard and painful to work or do much of anything. And with these symptoms it's like being on a roller coaster. Some day's are good and some are horrible. We finally got insurance again, so I went to the NS that was listed on this website (which I would never go back) anyway he did the usual neuro thing then looked at my MRI(which he said was the same from 09 but when I looked at it, it was different it was pointed now and just a little past the place it was in 09. Sorry anyway he told me that none of what I am complaining of is CM and that people don't just get symptoms when they get older, that if it was CM it would have started when I was young, and that herniation's don't get worse they stay the same. I was done at that point I started arguing with him at that point then gave up. He said that I don't have a syrinx.
I am just at a loss! I'm worn out, helpless! Can these be my CM even though I can walk fine and feel when they poke me in the hands and feet? Because every time I have seen a NS and they do those they automatically say it's not CM. If this isn't what is causing my problems, fine I just need to figure it out so I can live my life again!
No one has ever done a CINE MRI on me, just reg. MRI's. My primary doc has a friend who suffer's from CM and he suggested that I go to the Doctor that he sent his friend to. He actually does specialize in this, so I'm sending him my MRI's and report's to see what he say's. But I just really wanted to know if it can be CM even though the Neuro's test (walk,can you feel this and so on) is I would assume normal and him saying that the brain MRI show's no syrinx?
Sorry for this being so long winded, just very frustrated right now, just got back coming from the NS. Any help would be great!
May I start by asking when u had ur last MRI?....u should deff get another one if it was more then 6 months ago and u have new symptoms.Chiari symptoms can cycle, and can flare depending on ur activities...so u have to avoid certain things like lifting nething heavy, like a gallon of milk.....laundry baskets, children.....
Some with CM may never experience symptoms except for a trigger like a MVA, a hard cough or a fall...sometimes, they had symptoms all along, but bcuz they had them for sooooooooooooo long, they considered them "normal" and not symptoms...or bcuz the symptoms come and go, they saw them as separate issues and did not associate them with chiari.I am sure as u go along u may find u did have symptoms, but they were not as bad or consistent as they r since the MVA.
May I ask yet another question, where sis they look for ur syrinx?.....in the cervical spine only, or did they look in the thoracic and lumbar as well?
Actually I have been reading on here for a month or so now. And I got the NS from the list you posted. He was the only one on there for AZ, and I tried looking specifically on my insurance since a gave the option for a CM specialist. I had called and talked to Dr. Mark Ercius NS office and they assured me they knew all about CM have dealt with many cases. But he was a jerk, and when I brought up the fact that people can progressively get worse. That I have read almost everything I could to educate myself. He told me everything I read was wrong, so I dropped it.
My last MRI was actually yesterday, it was of the brain, but my 1st one where they discovered CM and that I had a slight reversal of the cervical curve was a cervical mri. Now that said with the MVA they did a CT and MRI of my lumbar where they found a lesion at the in my L1 Vertebral. But that is all. And I should also inform on the L1 they said was a birthmark, and the cervical curve thing "military neck" said it was a spasm.
And with the CINE MRI havent even gotten the chance to ask for one. They dismiss me after just a few minutes and interupt all the time. So I zip my lip and go to the next. Hoping that one way or another someone will figure something out.
I am hopeful that the NS that my primary is sending me to will figure something out one way or another. Now this NS actually specializes in CM did my research on him so finger's crossed.
The list of drs we have, is a list compiled by the members, drs that they have gone to and liked, and not all may be true chiari specialists and y I say research the dr u choose to go to, that the list is not meant as a referral......and u may need to see a few drs b4 u find one that is right for u.
I may like one dr, but u may not...even tho he is good...personality plays a role as u have to be comfortable with the dr.
Well the way u were treated unfortunately happens far too often.....I pray this next dr is the right one for u as well.
I am actually horrified and disappointed with myself after reading the causes of further herniation such as head and neck trauma. Some years ago I did a lot of clubbing with friends (I love my metal music) and head banged to the tunes!
How silly was that? I am amazed that I am okay at this point. *shakes head in disbelief*
Is surgery the only way to treat chiari 2. i was just diagnosed. The pain behind my eye is so bad all I can do is sleep. I am extremely nervous and waiting to go to a chiari doctor. Also one pupil is larger than the other.
I was recently diagnosed with Chiari in November after a MVA. Finally, I went to a neurosurgeon last week (after waiting 2 1/2 months for the appointment) and although he states my Chiari is severe, he won't discuss treatment options until I get more tests done. I have already had an MRI, but he is making me get 2 X-rays of my neck, a CT scan, and an EMG. Did you guys run into the same problems? My herniantion is 18 mm according to the MRI report. I didn't like how vague he was about treatment, especially after telling me mine was severe and I had already waited 2+ months for this appointment. I am afraid by the time I get all of these other tests done, it is going to be unbearable. I already have to take muscle relaxers and pain pills everyday that basically do nothing. The pain is unbearable already, I can't wait that much longer. It is so frustrating.
More testing is needed at this point...u may not know y, but I will try to explain....first, by severe he is only referring to the length meaning it is long, with more testing they can check to see if it is obstructing CSF flow...this is very important to do, as well as see if there r other issues/conditions going on as well. With a CSF obstruction a syrinx can form, so they need to rule out Syringomyelia (syrinx) this is a sac like cyst that fills with CSF, and if left untreated it can continue to grow...some grow slowly while others increase in size very rapidly.
Chiari can be congenital or acquired...knowing which one u have is also helpful. Many of us have symptoms our whole life, but since we have always felt that way it appears "normal" and we do not recognize many symptoms as symptoms until we learn more about Chiari and how it can and does affect us.
The pain u have is a result of the MVA and it triggered a flare....that is if ur condition is congenital....and with 18mm's I would think that is more the case...the MVA may have caused ur tonsils to herniate more then they already were, and also is causing the flare up of pain.
The EMG is a typical test as well are the xrays, do u know if they r flexion and extension xrays?
Were u dx'd with whip lash from the MVA, if so, that could be the main part of ur pain, I know as I also had whip lash and know how bad it can feel....u may need PT to help with that.
The 2 1/2 month wait was fast by many standards, and from Dx to surgery for me was more then a yr....u need to take ur time and know all that is going on or risk getting worse.
Ur Dr is doing what is needed, and we all need to learn patience as I know it is hard to wait, but if u rush into nething with this, u risk more issues and a lot more pain.
Look to ur daily activities if ur still doing them....and try to avoid those that cause the pain and symptoms to flare.We have a list of activities to avoid in the Health Pages.
Well finally after many doctors and things getting worse I have a neurosurgeon who believes me and listens. I now have a pain management doctor who is in contact with my PCP and neurosurgeon and plan is in motion and Jan. 13th I go back in to the neurosurgeon to discuss which surgery will be preformed and to schedule it. Now that I have a new MRI and a CINE MRI done as well. I am just happy that I now have a group of doctors listening and working with me. Its a very hard and long road just to get to this point (not that this journey will be over, but the relief alone of having doctors on your side is making this easier) and when things were getting hard for me to deal with between being in so much pain and all the other fun symptoms, it helped a lot to get on this site and read others posts.
The tonsils are a little lower than before, slight crowding at the foramen magnum and the flow study now shows a diminished flow posteriorly at the foramen magnum. And this was only a cervical MRI, when I saw the neurosurgeon and he aggreed that most of my problems are due to chiari I kinda forgot evertrything else. I was like a deer in headlights lol, I went in assuming that he would be like most of the doctors I have seen, so I forgot to talk to him about doing a MRI of my whole back seeming how it kills me 90% of the time and my spinal cord feels almost like a bungee cord and there is always a lot of pressure through my head,neck and whole back. So when I go in on Jan 13th to discuss my surgery I will also ask about the MRI of my whole back. I know the last time I got a MRI of my whole back after my MVA in 2009 they had found some lesions on some of my vertebrae and they chalked it up to birthmarks (which was not there before on my MRIS). But anyway we will see what he says. The pain management doc thinks he might want to first take care of what they found in my cervical MRI then preceed with anything else.
My daughter when to the two top specialist in the the country . We were told she had platybasia ( skull malformation ). When we went to John Hopkins they told her it wasn't severe enough for surgery. We came home back to square one. The pain management kept giving her meds and shots.i had had it by then I started researching and decided first to pray and then take her to an upper cervical doctor. We are on the right track.Recently we found one that does an MRI standing up.The Chari didn't show up on the other MRI's.She also had 4th stage endometriosis.
Endometriosis is common in those with Ehlers-Danlos as it is a connective tissue disorder and scarring....so do ask them to rule that out for her..as it can be helpful to the Chiari specialists if she is considered a surgical candidate....
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