is there such thing as....

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is there such thing as....

Postby sparks42 » Sat Jun 23, 2007 8:38 pm

Is there such thing as post traumatic SM.....with Chiari malformation?
can you get the CM from trauma as well?
- Syringomyelia, Scoliosis, Spinal Fusion, no CM
- 24 year old female
- London Ontario Canada
sparks42
 
Posts: 189
Joined: Fri Jun 08, 2007 1:17 pm
Location: London ON

Postby mac » Sat Jun 23, 2007 9:20 pm

Well, you've asked the $64,000 question! And I don't think there is a simple answer, but I'll try.

There IS plenty of evidence that CM can become symptomatic post injury. The belief here is that the CM was congenital but asymptomatic until post injury. There is one case from San Jose, or San Francisco, I believe, where a woman won her judgment against a bus company for making her (at the time)unknown Chiari become symptomatic.

When you combine this with a syrinx, well, which came first, the chicken or the egg? You could have the situation where the injury caused the CM to become symptomatic and thus flow was disturbed and a syrinx formed post trauma.

Or perhaps the situation where you were injured in the spine, where the syrinx formed, but that injury also flared up the CM. Or probably a lot of other combinations.

So far, I've talked about pre existing CM that was exacerbated by injury.

But...can trauma actually CAUSE CM?

If you describe CM as the way Dr. Milhorat et al redefined it in 1998, as being NOT the length of the tonsil herniation, but the size (small) of the cerebellum, then obviously, trauma could not cause CM.

So, that is true CM, that is: too small a cerebellum

I think (and I do have a bit of personal experience with this) that trauma CAN cause low lying tonsils which may not be true CM, but "look" like Chiari. This is true in my case. I fell straight onto the top of my head from a high position and with force (launched from back of horse when it stopped in front of a jump). This landing on the top of my head loaded my C1 evenly, breaking it 4 places. But it also crushed my skull down onto my Cspine and changing all natural angles.

Because I was not correctly stabilized post injury, and my C1 did not fuse itself, over 3 years, my skull rotated backwards (this all per Dr. Bolognese at TCI) and he said "all the angles and measurements do not apply to you." So, it looks like I have low lying tonsils and it looks like I have a steep tentorium angle (top of cerebellum, and one of the measurements to determine too small a cerebellum.) BUT, when my head will be extracted upwards and back more into the natural position via extraction fusion at TCI, it will be evident that my tentorium is not steeply inserted, and maybe my tonsils would not be that low then.

I know this is a lot of physiological lingo and maybe some people don't like it, but some do, I think, and want to learn these things. Especially those who might be dealing with it.

Thus, I tell my story only to show you that trauma can not cause true CM (too small a cerebellum, a congenital condition)...but in extreme and rare cases, it can cause angles to change which may give the same effect as CM, and to some it may look like CM. Thank God for true experts like Dr. Bolognese who could look quickly at the MRI and see exactly what was going on with me.

If you want the link to the judgment for the woman in the Bay Area, let me know and I'll try to find it.

I think the most likely scenario is if you were asymptomatic pre injury, and now you experience symptoms, the injury exacerbated a pre-existing condition (CM) and that caused a syrinx, or the direct blow to the spine or maybe even a person received a lumbar puncture in the hospital after a severe injury and one of those things also caused the syrinx.

Confused? Let me know if you need me to explain further.

mac
mac
 

Postby donbr » Sun Jun 24, 2007 7:00 pm

Hi
to answer your question the answer is yes.
My wife has cm without sm but two NSG that are considered experts are saying she could easilly develope sm because of the accident she was involved in in 03.
normally if there were no previous mri's and you were involved in an accident and they found cm and sm the cm would be considered the cause of the sm.
Can you get cm due to trauma yes but as mac said its very rare and it only looks like cm. another way that I dont think he mentioned was the brain sagging due to a severe csf leak. mri's would show the leak and if it stopped mris would show the spinal fluid. aquired cm due to csf leaks would be noticable on mri's

Take care
Don
Mac I have that case stored on my computer
donbr
 

thank you

Postby sparks42 » Sun Jun 24, 2007 10:22 pm

no that was not confusing....that was awesome. Thanks for the reply it was really insightful mac. Do you have the link to that case?
- Syringomyelia, Scoliosis, Spinal Fusion, no CM
- 24 year old female
- London Ontario Canada
sparks42
 
Posts: 189
Joined: Fri Jun 08, 2007 1:17 pm
Location: London ON

Postby mac » Mon Jun 25, 2007 12:01 am

Hi there...

I Googled a bit and found these two sites, one is for the attys who represented the woman, and the other is the full case report. I find it all very fascinating!


http://www.baumblake.com/CM/Newsletter/ ... ter-01.asp

full case report here:
http://napil.com/PersonalInjuryCaseLawDetail32221.htm

I think Don has the same from a different site, as well. Don, thanks for the info on the leak, that would sure make sense, wouldn't it!! I'm so sorry about your wife, Heidi's, situation. She is so blessed to have such a supportive husband as you. And don't forget, I'm a cowgal, not cowboy, ha!! I just use the name "mac" to ensure I'm not making any sense whatsoever. (Don, I know you know that!)

Sparks, I'm glad we could help you and that you could follow it. It wasn't an easy question to answer!

hugs
mac
mac
 

Postby mac » Mon Jun 25, 2007 12:12 am

One more thing, Sparks, is this link which will lead you to Dr. Thomas Milhorat's (et al) study report on redefining Chiari (from being the length of the tonsil herniation to the small size of the cerebellum).

http://statlink.duke.edu/medstat/pdf/milhorat-et-al.pdf

again, I hope these things help you on your journey.

mac
mac
 

Postby donbr » Mon Jun 25, 2007 12:21 am

OOOOOPS
sorry about that yes i know your a cowgirl must have forgotten the s
Don
donbr
 

Postby mac » Mon Jun 25, 2007 12:24 am

tee hee, Don....I always think people who are new here might think I'm a guy because of my username, and I knew you knew different...., we're old pals, for goodness sakes!

hugs to you and Heidi,

mac
mac
 


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