CMI maybe not the cause of neck pain and headaches?

[NeoGeoH]

My wife (39 otherwise totally healthy) was diagnosed by a Neuro (in early Dec 2011) with Small Fiber Neuropathy.  He ordered tons of tests to find the cause.  All came back normal, except her MRI with contrast showed CMI with 6mm.  No symptoms for CMI so she was labeled asymptomatic.  She got an infection and a blood clot from the IV when she got the MRI, and was put on an antibiotic and aspirin.  It (the infection and clot) cleared-up after a couple of weeks, but at about the exact same (late Dec) she felt nauseous, had neck pain, and a radiating headache.  This went on for about 4 days, and then began to wane.

On day 10, after the first occurrence of neck pain and headache, no neck pain or anything until she got a stress-inducing call from her Mom about 6 hours after getting up, then she immediately said an ache in her neck was back but in the middle half-way down, but this faded after about 45 mins of our talking and a walk.  She also said that her SFN was pretty much gone and only a little in her fingertips and mostly gone in her legs and toes.  Although later that night, she told me that she had SFN tingling and numbness in her left arm from mid-humorous down, this eventual went away about an hour later.  At 1a, this happened again and included her left leg, both were gone by 8a in the morning.  Weird.   That is a brief as I could be.

1. We are scared that her initial symptoms was her CMI had suddenly becoming symptomatic, but the location of the pain, now only and ache halfway down her neck, and the fact that it is immediately brought on by stress has me questioning this.  She doesn't seem to have any other classic CMI symptoms (dizziness, poor coordination, vision problems, and none of her headaches or neck pain/aches by coughing, sneezing, neck motion, or straining). Any thoughts?

2. Could the antibiotic have aided or caused the suspected Small Fiber Neuropathy to resolve?  Or is it just maybe a coincidence?  Not that I am complaining.

Thank you.

[NeoGeoH]

Thank you for the response.  We met with a neurosurgeon this week, prior to the appt. my wife had a CINE flow MRI and she didn't have restricted CSF flow, nor did she have any significant compression.  She stopped taking Gabapentin 100mg 3 times a day and most of her numbness, tingling, and random pains are gone.  Her only symptoms are just a little tingling in her left hand and foot, some neck pain and headaches.  The NS was wonderful and didn't think chiari was significant enough to be causing these symptoms, especially sine they are the only symptoms.  She ordered a cervical and spine MRI with flow to look for possible causes of her pain and headaches.  We are hopeful something can be found and treated as easily as possible.

[Christopher R Newey, DO]

Thanks for using the forum. I am happy to address your questions, and my answer will be based on the information you provided here. Please make sure you recognize that this forum is for educational purposes only, and it does not substitute for a formal office visit with a doctor.

Without the ability to examine and obtain a history, I can not tell you what the exact cause of the symptoms is. However I will try to provide you with some useful information.

Chiari malformation is an abnormal extension of the cerebellar tonsils (a structure in the posterior brain) through a hole in the skull called the foramen magnum. It is often asymptomatic or may present with headache, cranial nerve problems, sleep apnea, or hearing/vestibular problems. One associated feature with chiari’s is its association with syringomyelia, which is dilatation of the central canal in the spinal cord.

If not done, I would recommend that your mom have her neck imaged with MRI. She may also be a candidate for special imaging called phase-contrast MRI to examine the CSF flow.

The cause of the low lying cerebellum could be genetics/development or it could be trauma, to name a few.

The resolution of the small fiber neuropathy with antibiotic is likely coincidence. It does raise the question though why she has small fiber neuropathy. There are several causes of small fiber neuropathy, including diabetes, vitamin deficiencies, and autoimmune problems.

I would recommend that your mother follow up with her neurologist for further evaluation of her conditions.  

Thank you for this opportunity to answer your questions, I hope you find the information I have provided useful, good luck.