Partially empty sella - Chiari malformation seen

[LindaG]

First thank you for the opportunity to learn a little bit more.  I had an MRI for dysphagia and neurologist rule out of MS.  The MRI results showed "partially empty sella" and chaiari malformation seen.  Normal intracerebral flow voids are identified.  The remainder of the report shows no areas of abnormal signal intensity and no abnormal enhancement.  The Impression was: normal MRI of the brain with and without contrast.  My symptoms have been for quite some time.  Years, pain in the back of the neck, anxiety attacks, dizziness, feeling faint, paralysis in left arm and muscle spasms in legs and fingers.  As a child I was thought to have arthritis for the pain in my joints (fingers, knees, hips).  My symptoms have gotten progressively worse with a main symptom of being unable to swallow which led me to the neurologist.  I had a video swallow done, saw a GE all was normal other than IBS.  I am curious as to whether the partially empty sella/chiaria malformation could be connected, could be my diagnosis?  I have had a complete hysterectomy and oophorectomy 2 years now and use hormone replacement.  The neurologist didn't even speak to me after the results of the MRI and the receptionist told me normal and that's it.  I requested a copy and read on to find the info about the sella and chiari malformation.   Any advice (not a diagnosis) just advice would be GREATLY appreciated.   I feel as if I am running an endless race and I know there is an answer somewhere.   Please advise....I would be most grateful for an opinion.
Much obliged,
Linda G.

[CCF-Neuro-M.D.-JT]

As I preface all my responses when I am asked to comment on MRI results, I have not personally reviewed your films nor have I examined you so I cannot give you an accurate diagnosis. But from your question, it doesn't sound like you have the typical symptoms of empty sella syndrome which can present like a pituitary mass due to pressure on the normal place where it sits (called the sella which means saddle in some language). However, you may have some symptoms of the Chiari malformation which in many patients can be clinically silent. As you know, the malformation refers to the back of the brain which includes the cerebellum and brainstem being too low. Persistent headache, neck pain and problems with walking are some of the more common symtpoms. DIfficulty swallowing and speaking can also be a problem if the brainstem is being compressed as well as spasticity.

We always have to be careful with patients who have a Chiari malformation on a scan, because many times it doesn't correlate well with the symptoms and if they have unnecessary corrective surgery they can end up with even more problems.Also, it could have been overcalled on the MRI by the radiologist.

If you're still having these symptoms and are not getting much support from your neurologist, you should get a second opinion. It's important for patients like you to understand the results of the diagnostic testing. So try to contact your neurologist again so you can sit down with him and go over the scan, or find another one. As for your symptoms, you may need further workup including possibly an EMG study to see if there's a correlation with the spasms, weakness and difficulty swallowing. An MRI of your cervical spine may also be helpful depending on your exam. Best of luck.

[LindaG]

:(  nobody has an opinion not even the doc?  It says questions for diagnosis will be ignored or deleted, is mine being ignored?  I will rephrase if necessary.   :*(  Help !

[MrsHat]

Be patient they will answer your question.  I think it may be delayed due to the fact of what our country went through yesterday.  Everyone's lives were put on hold.  Best of luck for a diagnosis.

[LindaG]

I really did not mean to be insensitive to the tragedy that this Country has faced.  Inpatient yes, insensitive no.  My apologies for coming across that way.  I just saw that the Doctor had answered another question to my surprise with what was going on yesterday and took it from there.  Again, my apologies for any insensitivity that may have come across, it certainly was unintentional :(

[LindaG]

Thank you so much for your opinions and advise.  I will take them to heart.  One more quick little thought when you mentioned the spine.   At one point when I was having so much neck pain (could not move my head) I went to a chiropractor and he did an xray and told me I had "military neck"...straight neck instead of the natural curvature (like a "c" he said).  Just curious if that could be any correlation or I'm just grasping at straws.   Well again, THANK YOU for what you do, thank you very much !

[LindaG]

See above

[LindaG]

Thank you so much for your opinions and advise. I will take them to heart. One more quick little thought when you mentioned the spine. At one point when I was having so much neck pain (could not move my head) I went to a chiropractor and he did an xray and told me I had "military neck"...straight neck instead of the natural curvature (like a "c" he said). Just curious if that could be any correlation or I'm just grasping at straws. Well again, THANK YOU for what you do, thank you very much !

[sewer]

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