Neurology Exam Questions

I was diagnosed with Chiari I Malformation and Syringomyelia, back in October 2009.  The cerebellar tonsils are herniated 14 mm and the syrinx spans from C6-T3 and is 8 mm in diameter.  I have been going to a  neurologist every 3 months since then and would always have a very standard exam.  This time, he also tested the sensory system by using objects to sense the way temperature and pain were effecting me.  I felt more pain in the knee than the foot and it was much colder at the knee than the foot.

I don't know if this is a good thing or not.  After explaining my symptoms to my NL and after performing the exam (the worst being my headaches), he is sending me for 3 more MRIs - Brain, Head and Carotid.  Can someone explain to me why he is doing this?  I would have asked him, except he only mentioned the brain MRI to me.  It wasn't until I was getting forms for the MRI and MRAs that I was made aware of the head and carotid exams.

Thanks,
Erin

[Dr. A. Srivastava]

Hi, Thank you for your question. In Chiari malformations, the pressure in brain increases which manifests itself as dizziness, diplopia (blurring of vision), migraine like headaches, muscle weakness, facial pain, hearing problems, and extreme fatigue. Sometimes this malformation causes dizziness while working with hands above the shoulder level. Treatment of Chiari malformation depends on the form, severity and associated symptoms. No treatment is required in asymptomatic cases other than regular monitoring. Symptomatic patients may require surgery (posterior fossa decompression surgery). The requirement and pros and cons of surgery in your case should be discussed with your doctor as he knows the severity of problem. Hope this helps.

[Eiresquid11]

Hello Doctor,

Thank you so much for your prompt response.  I greatly appreciate it.  I suppose I should mention that I understand the symptoms of Chiari as well as the necessity for surgery in some cases, while not in others.  My brother was also diagnosed with chiari and had decompression surgery back in November 2008.

I was completely asymptomatic and completely unaware that I even had chiari until I was hit by a truck while walking across the street.  I had sprained my neck due to that and was sent for an MRI to determine if any other damage was done.  It was then they discovered the chiari and syringomyelia.

While I was suffering from headaches prior to the accident, it never even occurred to me to get checked for chiari, because I work at a desk under fluourescent lights all day and attributed my headaches to that...they were never severe or bothersome.

My main questions are why would my doctor have ordered carotid and head mra's?  I don't know what symptoms I mentioned or what was revealed to him during my exam that would make him want to order them.

Secondly, is it normal or abnormal for me, during the exam to feel more pain and cooler temperature in my leg than my foot?

Thank you,
Erin

[*Stormy*]

HI Erin

Of course, I am not a DR (lol) but I am going to take a stab at it...

Maybe he is trying to rule out that your problems are being caused by a stroke or that it is not a vessel issue...if a part of your brain wasn't getting the oxygen you need then it could cause a lot of the same symptoms. The carotid one I would think would be to make sure that the artery is not compressed or that there are no flow issues there. For example, I have heard lately that they have made a breakthrough with MS, that most ppl that have it have been found to have a diminished flow in some main arteries to the brain. So you can see what a diminished flow could cause... Again, I am just speculating..but I am glad just for the fact that your NL is looking at everything!

I also couldn't feel coldness almost up to my knee and I have certain numbness below my knee...I can feel a touch on my lower leg but it is like I am being touched through something (like a piece of cloth). Does that make sense? I can't remember, do you have leg involvement (unstable gait)? So no it is not normal for the average person but is something that can be caused by Chiari.

Carolyn

[selmaS]

Hi...I also had my carotid artery check as well in fact it was doing the US that they found an issue with my thyroid...I am not sure y it is done, but glad I finally had a reason to get retested for the autoimmune thyroid issue I felt I had and the ENDO didn't feel necessary to do further testing or give meds for.

And in reading what Carolyn mentioned does sound familiar.....There r instances where some patients have both chiari and MS...and even some mis dx'd as MS when in fact it was chiari...so the dr giving u a thorough check up is doing  the best he can for u!!

"selma"