My busy schedule doesn’t often provide much time for television, but I must confess there is one program that provides a welcome diversion to daily life: CSI. I miss Gil Grissom, I’m glad Sarah’s back, and I’m getting used to Dr. Ray. Imagine my surprise when their fictional lives collided with my real world life: their victim had a Chiari malformation!
The episode, titled Internal Combustion, begins with a dead teenager about to undergo an autopsy. The external exam turns up no obvious cause of death, but when the skull is removed all is revealed: the victim had severe brain edema. But why? There is no brain trauma. An MRI scan reveals a herniated cerebellum and brain stem: a Chiari malformation. Dr. Ray tells us most patients are unaware they have Chiari until a minor trauma or neck flexion triggers symptoms.
So far, I’m not sure if I should be pleased or not. Chiari has made prime time television, and it’s true, many people become aware of the condition after a minor trauma. But they don’t die. And this is CSI– someone is always dead, and in this case it’s the Chiari patient!
The reenactment of our victim’s demise is even more frightening. Here, they picture a perfectly healthy, conscious, teenage boy walking down a school hallway when he suddenly drops dead. Yes, literally falls to the ground-dead. My heart begins to ache as I imagine parents seeing this and asking themselves, “Could that happen to my asymptomatic child?”
I think the answer is a resounding no. The plot line seems to have several serious flaws. The victim died of brain edema due to extremely high intracranial pressure. We know this can be fatal. But do people suffering from extremely high intracranial pressure drive themselves to school and walk down halls with the appearance of normalcy? Wouldn’t the high pressure cause a severe incapacitating headache, vomiting, and a loss of consciousness well before death occurred?
Dr. Robert Keating, pediatric neurosurgeon at Children’s National Medical Center in Washington, D.C. says, “Despite Hollywood’s infatuation with the endless mysteries of Neurosurgery, I am continually amazed by the overall lack of medical accountability in their attempt at prime-time drama. Although there are rare reports of sudden death in connection with Chiari malformations, the recent episode of CSI dealing with this same issue raises more questions than it answers. Nevertheless, for the record, it is exceptionally rare for an individual with a Chiari malformation to inexplicably die without due cause. It is more likely that patients with chronic issues may be at a greater risk from trivial trauma and this is usually preceded by Chiari symptomatology. Consequently, should an individual begin manifesting occipital headaches, neck pain, upper/ lower extremity weakness/ numbness or paresthesias, trouble swallowing / phonation or difficulty breathing after head or neck trauma, one should be alert to the rare possibility of exacerbation of a Chiari malformation and seek medical attention. For the majority of patients with Chiari malformations, the likelihood of a CSI incident remains remote and should not in turn add any undue stress or anxiety to their condition.”
So, while we can rejoice that Chiari malformation is well-known enough to be used in popular dramas, we must now deal with the flip-side of the triumph: lots of inaccurate information! The bottom line is sudden death from Chiari in a patient with no other medical complications makes good fiction, but is not very realistic.
You can see the promo video for this episode by clicking here.
What do you think? Share your reaction to seeing Chiari portrayed on CSI.
