Introduction

If you’re an older adult, you may have dismissed trembling hands or a shaking head as a normal part of the aging process. But it’s more likely your shakiness is a sign of a movement disorder called essential tremor.

Although essential tremor can affect almost any part of your body, trembling occurs most often in your hands, especially when you try to do simple tasks such as drinking a glass of water, tying your shoelaces, writing or shaving. Sometimes, you may also have trembling of your head, voice or arms.

Essential tremor is the most common of the many movement disorders. It’s far more common than Parkinson’s disease, with which it may sometimes be confused. Unlike Parkinson’s disease, however, essential tremor doesn’t lead to serious complications. In fact, the word “essential” in essential tremor means the disorder isn’t linked to other diseases.

For some people, essential tremor may be distressing but not debilitating. Others may find that their tremors make it difficult to work, perform everyday tasks that require fine-motor skills or do the things they enjoy. Severe tremors can lead to social withdrawal and isolation. Fortunately, a variety of treatments exist that may help bring your tremors under control.

Signs and symptoms

Essential tremor often begins gradually. Sometimes it appears during adolescence. More often, though, tremors begin in mid- to late life.

The most common sign is a trembling, up-and-down movement of your hands, although your arms, legs, head and even your tongue and voice box (larynx) also may be affected. Most people have tremors in both hands. Some people have tremors in only one hand, though the tremors often progress to include both hands.

Tremors usually occur only when you engage in a voluntary movement, such as drinking a glass of water, writing or threading a needle. Actions requiring fine-motor skills — using utensils or small tools, for example — may be especially difficult. Fatigue, anxiety and temperature extremes make the signs worse, but tremors usually disappear when you’re asleep or at rest.

Some people have relatively mild tremors throughout their lives, while others develop more severe tremors and increased disability over time. Effects of worsening tremors may include:

• Difficulty holding a cup or glass without spilling
• Difficulty eating normally
• Difficulty putting on makeup or shaving
• Difficulty talking, if your voice box or tongue is affected
• Difficulty writing — handwriting may become increasingly large, shaky and illegible
• The inability to perform actions requiring fine-motor skills, such as playing an instrument or drawing

Essential tremor vs. Parkinson’s disease
Many people associate tremors with Parkinson’s disease, a serious movement disorder. But essential tremor and Parkinson’s disease aren’t related, and the two conditions differ in key ways:

• When tremors occur. Essential tremor of the hands typically occurs when your hands are in use. Tremors from Parkinson’s are most prominent when your hands are at your sides or resting in your lap. This type of tremor usually decreases with movement of the hands.
• Associated conditions. Essential tremor doesn’t cause other health problems, whereas Parkinson’s is associated with a stooped posture, slow movement, a shuffling gait, speech problems other than tremor and sometimes memory loss.
• Parts of body affected. Essential tremor can involve your hands, legs, head and voice. Tremors from Parkinson’s typically affect your hands, but not your head or voice.

Causes

About half of all cases of essential tremor appear to occur because of a genetic mutation. This is referred to as benign familial tremor. Genes are information centers in your cells that control your body’s growth, development and function. A mutation in just one gene can greatly alter the way your body works. Researchers have identified two genes that appear to be involved in essential tremor. It’s possible that mutations in other genes may also lead to the condition.

Exactly what causes essential tremor in people without a known genetic mutation isn’t clear. Doctors do know that the problem occurs in the brain circuits that control your movements. Studies using an imaging technique called positron emission tomography (PET) scanning show that certain parts of the brain — including the thalamus — have increased activity in people with essential tremor. More research is needed to understand the precise mechanism behind the disease.

Risk factors

Benign familial tremors are an autosomal dominant disorder, which means that a defective gene from just one parent is needed to pass on the condition. If you have a parent with a genetic mutation for essential tremor, you have a 50 percent chance of developing the disorder yourself. The only other known risk factor is older age. Although essential tremor can affect people of all ages, it usually appears in late middle age or later.

When to seek medical advice

See your doctor if tremors make it hard to perform daily activities or prevent you from living your life as fully as you’d like. Your doctor can determine whether essential tremor is causing your problem and may be able to suggest treatments that will ease your symptoms.

Screening and diagnosis

You’ll receive a diagnosis of essential tremor only after your doctor has ruled out other possible causes for your symptoms. For that reason, you may undergo blood, urine and neurological tests to check for problems such as thyroid disease, heavy metal poisoning, drug side effects and Parkinson’s disease.

In addition, your doctor will take a complete medical history and perform a thorough physical and neurological exam that may include checking your tendon reflexes, your muscle strength and tone, your ability to feel certain sensations, and your posture and coordination.

The tremor itself may be evaluated in several ways, including performance tests in which you’re asked to write, drink from a glass or hold a piece of paper.

Treatment

Most people with essential tremor don’t need treatment beyond reassurance that the condition isn’t a sign of a more serious disease. Lifestyle changes — which include getting plenty of rest and avoiding stressful situations and stimulants such as caffeine — may help ease the tremors. Most people with essential tremor find that fatigue, anxiety, sleep deprivation and even temperature extremes make their tremors worse.

If lifestyle changes don’t help and tremors are keeping you from doing the things you enjoy, your doctor may recommend these options:

Medications
Medications provide relief from tremors roughly half the time. They include:

• Beta blockers. Normally used to treat high blood pressure, beta blockers, such as propranolol (Inderal), help relieve tremors in some people. Because beta blockers are especially likely to cause dizziness, confusion and memory loss in older adults, they may be a better choice for younger people. They may not be an option if you also have asthma, diabetes or certain heart problems.
• Anti-seizure medications. These drugs, especially primidone (Mysoline), may be effective in people who don’t respond to beta blockers. The main side effects are drowsiness and flu-like symptoms, which usually disappear within a short time.
• Tranquilizers. Doctors sometimes use drugs such as diazepam (Valium) and alprazolam (Xanax) to treat people whose tremors are made much worse by tension or anxiety. Side effects can include confusion and memory loss. Additionally, these medications should be used with caution because they can be habit-forming.
• Botulinum toxin type A (Botox) injections. You’re probably familiar with Botox as a treatment for facial wrinkles, but it can also be useful in treating some types of tremors, especially of the head and voice. Botox injections can improve problems for up to three months at a time. When used to treat hand tremors, Botox can sometimes cause weakness in your fingers.

Surgery
Surgery may be an option for people whose tremors are severely disabling and who don’t respond to medications. Deep brain stimulation (DBS) is a treatment involving a brain implant device called a thalamic stimulator may be appropriate if you have severe tremors and if medications aren’t effective. A pacemaker-like chest unit transmits electrical pulses through a wire to a lead implanted in your thalamus. The pulses, which are painless, may interrupt signals from your thalamus that help cause tremors. You turn the pulse generator on and off by passing a magnet over your chest.

Self-care

The following suggestions can sometimes help reduce or relieve tremors:

• Avoid caffeine. Caffeine can cause your body to produce more adrenaline, which may make your tremors worse. Avoid other stimulants as well.
• Use alcohol sparingly. Some people notice that their tremors improve for up to an hour after they drink alcohol, but drinking isn’t a good solution for people with essential tremor. That’s because tremors tend to worsen once the effects of alcohol wear off. What’s more, larger amounts of alcohol eventually are needed to relieve tremors, which can lead to chronic alcoholism. If you have essential tremor, it’s best to drink sparingly or not at all.
• Learn to relax. Stress tends to make tremors worse, and a relaxed state often improves them. Although it’s not possible to eliminate all stress from your life, you can change how you react to stressful situations using a range of relaxation techniques. These include deep breathing, progressive muscle relaxation, guided imagery and massage as well as disciplines such as yoga and tai chi. Many people also find that physical exercise — walking, jogging, swimming or biking — is a great stress reliever.
• Rest well. Fatigue can exacerbate tremors. Try to get at least seven hours of sound sleep every night. If you have trouble falling asleep, wake up repeatedly or awaken early and can’t go back to sleep, talk to your doctor.
• Strengthen your hands. Your doctor may recommend working with a specialist to learn exercises to promote more stability in your hands and wrists. These usually involve using 1- to 2-pound weights strapped to your wrists. You can continue doing these exercises at home.
• Consider joining a support group. For many people, essential tremor can have serious social and psychological consequences. If the effects of essential tremor are making it hard to live your life as fully as you once did, consider joining a support group for people with the disorder. Support groups aren’t for everyone, but you may find it helpful to have the encouragement of people who understand what you’re going through. Or you might want to consider seeing a counselor or social worker who can help you meet the challenges of living with essential tremor.

Essential tremor is a post from: by the pines

Introduction

“Cerebral palsy” is a general term that describes a group of disorders that appear during the first few years of life and affect a child’s ability to coordinate body movements. These disorders are caused by damage to a child’s brain early in the course of development. The damage can occur during fetal development, during the birth process or during the first few months after birth.

Cerebral palsy ranges from mild to severe. Physical signs of cerebral palsy include weakness and floppiness of muscles or spasticity and rigidity. In some cases, neurological disorders — such as mental retardation or seizures — also occur in children with cerebral palsy.

Cerebral palsy isn’t curable. However, getting the right therapy for your child can make a big difference. Today, children with cerebral palsy benefit from a wide range of treatment options and innovations.

Signs and symptoms

There are three major types of cerebral palsy:

• Spastic cerebral palsy. Most children with cerebral palsy have spastic cerebral palsy. This form of the condition causes muscles to stiffen, which makes movement difficult. It can affect both legs (spastic diplegia), or it can affect one side of the body (spastic hemiplegia). In the most severe cases, all four limbs and the trunk are affected (spastic quadriplegia).
• Athetotic cerebral palsy. About one in five people with cerebral palsy have this form, which is also referred to as extrapyramidal cerebral palsy. It affects the entire body and often causes uncontrolled, slow movements.
• Ataxic cerebral palsy. This is the least common of the major types of cerebral palsy. It affects balance and coordination.

Some children have signs and symptoms of more than one type of cerebral palsy, which may be referred to as a mixed form of the condition.

In general, children with cerebral palsy exhibit a wide variety of signs and symptoms, ranging from mild to severe. Cerebral palsy symptoms don’t worsen with age. They may include:

• Lack of muscle coordination when performing voluntary movements (ataxia)
• Stiff muscles and exaggerated reflexes (spasticity)
• Asymmetrical walking gait, with one foot or leg dragging
• Variations in muscle tone, from too stiff to too floppy
• Excessive drooling or difficulties swallowing, sucking or speaking
• Tremors
• Difficulty with precise motions, such as writing or buttoning a shirt

Some children with cerebral palsy have severe mental retardation, but others are extremely bright. Many need a wheelchair and extensive, lifelong care, but some require little or no special assistance.

Causes

Cerebral palsy results from an abnormality in or injury to the cerebrum — the largest area of the brain, which controls sensation and voluntary motor function. Although cerebral palsy affects movement, the underlying problem originates in the brain, not in the muscles themselves.

A small number of children with cerebral palsy acquire the disorder after birth. In these cases, doctors can sometimes pinpoint a specific reason for the neurological problem. For example, cerebral palsy can develop after an illness during early infancy, such as bacterial meningitis — an infection and inflammation of the membranes and fluid surrounding the brain and spinal cord. It can also be the result of a head injury.

However, doctors don’t completely understand the cause of most cases of cerebral palsy, which are present at birth (congenital). For many years, doctors and researchers believed that cerebral palsy was caused by a lack of oxygen during birth. Now they believe that only a small number of cases are caused by problems during labor and delivery.

Some possible causes
Doctors and researchers have now identified many possible causes of congenital cerebral palsy, including:

• Maternal infection during pregnancy, such as rubella or other viral infections
• Severe jaundice in newborns, which may be caused by infection, severe bruising or problems with red blood cells due to ABO or Rh incompatibility — two incompatibilities between the blood of the mother and her fetus
• Abnormal brain development before birth, resulting from genetic causes or metabolic disorders
• Disturbance to brain circulation before birth, caused by an artery spasm or blood clot, similar to a stroke in adults

Risk factors

Most children with cerebral palsy don’t have any apparent problems during development in the womb and birth. But some factors may increase the risk of cerebral palsy:

• Babies that are premature or have a low birth weight 
• Fetuses in a feet-first position (breech presentation) at the beginning of labor
• Complicated labor and delivery
• Maternal infection during pregnancy
• Health problems in the mother during pregnancy that impair normal blood circulation to the uterus and placenta

Meconium staining of amniotic fluid, caused by stool passed by the fetus in utero, also may indicate prenatal difficulties. However, most children with one or more of these risk factors don’t develop cerebral palsy.

When to seek medical advice

If your baby seems to display weakness or paralysis in a limb or isn’t developing motor skills at the expected times, talk to your family doctor or pediatrician. Every baby develops at his or her own pace, so there’s no need to panic if your baby doesn’t meet one of the monthly milestones described in a parenting book. But it’s important to share any concerns about your baby’s development with your doctor.

For example, children usually become right-handed or left-handed by age 2. Infants who appear right-handed or left-handed at younger ages may actually have impaired movement of one hand.

Screening and diagnosis

Early signs of cerebral palsy may be present from birth, but it’s often difficult to make a definite diagnosis during the first six months. Cerebral palsy is generally diagnosed by age 1 or 2.

If your child shows some signs of cerebral palsy, your doctor will likely schedule an appointment to observe your child and to talk to you about your child’s physical and behavioral development. In this evaluation, your doctor will check your child’s reflexes, muscle tone and movements. Additional tests may rule out other disorders that can cause movement problems. Your doctor may have your child undergo one or more of these procedures:

• Computerized tomography (CT) scan. Images created with a CT scanner show the structure of your child’s brain, as well as the presence and extent of any damage.
• Magnetic resonance imaging (MRI) scan. The cylinder-shaped MRI scanner uses no X-rays. Instead, a computer creates tissue-slice images of the brain from data generated by a powerful magnetic field and radio waves. These images can be viewed from any direction or plane.
• Other tests. Some children may need genetic or metabolic tests to help rule out other conditions.

You may be referred to a specialist to help determine if your child has cerebral palsy or some other condition. Your doctor may recommend a visit to a doctor with specialized training in the development of the brain and nervous system in children (pediatric neurologist), a doctor who specializes in childhood development (developmental pediatrician), or a doctor who specializes in physical medicine and rehabilitation (physiatrist).

Complications

Besides difficulty with movement and posture, cerebral palsy may result in these health problems:

• Development of joint deformities or dislocation, if there’s considerable spasticity
• Nutrition problems, if there are swallowing or feeding difficulties

Some children with cerebral palsy will have multiple handicaps and may require long term care. Some of the associated problems may include:

• Difficulty with vision, hearing and speech
• Dental problems
• Mental retardation
• Seizures
• Abnormal sensation or perception
• Urinary incontinence

Treatment

The brain abnormality or damage that underlies cerebral palsy doesn’t worsen with time, but children with cerebral palsy often require long-term care. The type and amount of treatment depend on how many problems your child has and how severe they are.

The goal of cerebral palsy treatment is to help your child reach his or her maximum potential. Reaching this goal typically requires a multidisciplinary team of professionals, including physicians, therapists, psychologists, educators, nurses, special education teachers and social workers. These professionals work together to address issues of social and emotional development, communication, education, nutrition and mobility. Cerebral palsy treatments may include:

• Physical therapy. Physical therapists work to help your child reach his or her maximum potential for functional independence through a variety of approaches including exercise, mobility training, orthotics or braces, and use of other equipment. Muscle training and exercises may help your child’s strength, flexibility, balance, motor development and mobility, as well as ease caregiving.
• Occupational therapy. Therapists in this field focus on the development of fine motor skills and self-care skills. Using exercises, facilitated practice, alternative strategies and adaptive equipment, they work to promote your child’s independent participation in daily activities and routines in the home, school and community. They may also address difficulties with feeding and swallowing.
• Speech therapy. A speech therapist works with your child on both the receptive (understanding) part of speech and language as well as the expressive part (talking). Speech therapists help improve your child’s ability to speak clearly or communicate using alternative means such as an augmentative communication device or sign language. Speech therapists may also help with difficulties related to feeding and swallowing.
• Vision and hearing aids. Depending on how severely your child’s eyes are affected, he or she may need eyeglasses or surgery to correct a condition, such as cross-eye or other inability of the eyes to focus together properly (strabismus). Hearing aids may help correct any hearing problems.
• Orthotics. A variety of orthotics or “braces” or “splints” may be recommended for your child. These may be used on your child’s legs, arms or trunk. Some of these supports are used to help with function, such as improved walking. The purpose of others is for additional stretching or optimal positioning of a joint. You’ll need to pay careful attention to your child’s skin under the orthotics to make sure that the skin isn’t becoming irritated. Just like your child needs new shoes as they grow, they may also need new orthotics over time. Your rehabilitation team can help you decide which type of orthotic is most useful at what time of your child’s life.
• Medications. These may include muscle relaxants to ease muscle spasticity and anticonvulsants to reduce seizures. Injections of botulinum toxin (Botox) directly into spastic muscles also may be helpful.
• Surgery. Children with severe contractures or deformities may need surgery on tendons, bones or joints to place their arms and legs in their correct positions. This can make it easier to use a walker, braces or crutches. Children with severe spasticity who haven’t responded to oral medications may also benefit from surgical procedures.One option is dorsal rhizotomy, a procedure in which surgeons identify and cut a portion of the spinal sensory roots that provide input to spastic leg muscles. Another option is intrathecal baclofen. In this procedure, an intraspinal catheter is placed and connected to a reservoir under the skin of the abdomen. This mechanism continuously pumps small amounts of an antispastic medication called baclofen into the fluid around the spinal cord.

  These surgeries require careful screening and an expert team of health professionals, including pediatric neurosurgeons, orthopedic surgeons, pediatric neurologists, pediatric physiatrists and physical therapists.

• Assistive technology. A range of devices and gadgets can help with communication, mobility and daily tasks. Assistive technology includes such small things as rails, grab bars, magnifiers, and Velcro grips attached to forks and pens to make them easier to grasp. It also includes more expensive, high-tech tools, such as customized wheelchairs, voice communication devices, computer software programs, and positioning equipment that puts a child in the correct posture to sit or stand with other kids or family members. These devices and gadgets for school and home can make a big difference in the lives of children with cerebral palsy.

Prevention

For more than a century, doctors have hoped that by somehow improving labor and birth practices, they could reduce the incidence of cerebral palsy. But these rates have remained fairly constant, despite increased prenatal care, electronic fetal monitoring, prenatal ultrasound and increased use of Caesarean section delivery over the past 25 years.

Fewer babies now develop cerebral palsy as a consequence of birth injury. However, larger numbers of extremely premature babies survive, and some will develop cerebral palsy.

Most cases of cerebral palsy can’t be prevented, despite the best efforts of parents and doctors. But, if you’re pregnant, you can take these steps to keep healthy to minimize the possibility of pregnancy complications:

• Make sure you’re immunized. Immunization against diseases such as rubella may prevent an infection that could cause fetal brain damage.
• Take care of yourself. The healthier you are heading into a pregnancy, the less likely you’ll be to develop an infection that may result in cerebral palsy.
• Seek early and continuous prenatal care. Regular visits to your doctor during your pregnancy are a good way to reduce health risks to you and your unborn baby. Seeing your doctor regularly can help prevent premature birth, low birth weight and infections.

Coping skills

When a child is diagnosed with a disability, it forces the whole family to face a range of new challenges. Here are a few tips for caring for yourself and your child:

• Foster your child’s independence. Encourage any effort at independence, no matter how small. Just because you can do something faster and quicker doesn’t mean you should.
• Be an advocate for your child. You are an important part of your child’s health care team. Don’t be afraid to speak out on your child’s behalf or to ask tough questions of your physicians, therapists and teachers.
• Find support. A circle of support can make a big difference in helping you cope with cerebral palsy and its effects. As a parent, you may feel grief and guilt over your child’s disability. Your doctor can help you locate support groups, organizations and counseling services in your community. Your child may benefit from family support programs, school programs and counseling.

Cerebral palsy is a post from: by the pines

Introduction

Chiari malformation is a condition in which brain tissue protrudes into your spinal canal. It occurs when a portion of your skull is abnormally small or misshapen, pressing on your brain and forcing it downward. Although Chiari malformation is uncommon, it’s now diagnosed more frequently, largely due to improved imaging tests.

Chiari malformation is usually present at birth (congenital), but it can develop in some children after they are born. Signs and symptoms may not occur until adulthood.

Doctors categorize Chiari malformation into several types, depending on the amount of brain tissue that is pushed down into the spinal canal, and whether developmental abnormalities of the brain or spine are present. The more common types are less severe and involve less displaced tissue. Other types are rare and more severe.

Treatment for Chiari malformation depends on its severity and the characteristics of your condition. Regular monitoring, medications and surgery are all treatment options.

Signs and symptoms

Some people with Chiari malformation have no signs or symptoms. Their condition is detected only when tests are performed for unrelated disorders. However, depending on the type and severity, Chiari malformation can cause a number of signs and symptoms.

Signs and symptoms usually start during infancy, although they can begin in adolescence or adulthood. Even when they’re less serious, as in the more common types I and II, signs and symptoms still can be problematic and life disrupting.

Headaches, often severe, are the classic symptom of Chiari malformation. They are typically precipitated with sudden coughing, sneezing or straining. People with Chiari malformation type I also can experience:

• Neck pain (running down the shoulders at times)
• Unsteady gait (problems with balance)
• Poor hand coordination (fine-motor skills)
• Numbness and tingling of the hands and feet
• Dizziness
• Difficulty swallowing (sometimes accompanied by gagging, choking and vomiting)
• Vision problems (blurred or double vision)
• Slurred speech

Less often, people with Chiari malformation may experience:

• Ringing or buzzing in the ears (tinnitus)
• Poor bladder control
• Chest pain, in a band-like pattern around the chest
• Curvature of the spine (scoliosis) related to spinal cord impairment
• Abnormal breathing — specifically, sleep apnea characterized by periods of breathing cessation during sleep

Some people have occasional “dropping” episodes — feeling faint and unexpectedly collapsing to the floor, losing consciousness for a few seconds.

In Chiari malformation type II, in which a greater amount of tissue protrudes into the spinal canal compared with type I, the signs and symptoms can include not only those above, but also myelomeningocele, a form of spina bifida in which the backbone and the spinal canal have not closed properly before birth. This type is sometimes called Arnold-Chiari malformation.

In one of the most severe types of the condition, Chiari malformation type III, a portion of the lower back part of the brain (cerebellum) or the brainstem extends through an abnormal opening in the back of the skull.

In people with the even more severe Chiari malformation type IV, the brain itself has never developed normally.

Causes

Chiari malformation occurs when the section of the skull containing the cerebellum is too small or is deformed, thus putting pressure on and crowding the brain. There’s no clear cause of this misshapen skull.

When the cerebellum is pushed into the upper spinal canal, it can interfere with the normal flow of cerebrospinal fluid (CSF) that protects your brain and spinal cord. This impaired circulation of CSF can lead to the blockage of signals transmitted from your brain to your body, or to a buildup of spinal fluid in the brain or spinal cord. Alternatively, the pressure from the cerebellum upon the spinal cord or lower brainstem can cause neurological signs or symptoms.

Risk factors

Chiari malformation occurs about three times more often in females than in males.

There’s some evidence that Chiari malformation runs in some families. However, research into a possible hereditary component is still in its early phase.

When to seek medical advice

If you have any of the signs and symptoms that may be associated with Chiari malformation, see your doctor for an evaluation.

Because many symptoms of Chiari malformation can also be associated with other disorders, a thorough medical evaluation is important. Head pain, for example, can be caused by migraines, sinus disease or a brain tumor, as well as Chiari malformation. Other signs and symptoms overlap with conditions such as multiple sclerosis.

For a thorough examination, your primary care doctor may refer you to a specialist in the brain and nervous system (neurologist) and to a specialist in interpreting X-rays and other imaging (radiologist) to conduct the most appropriate tests.

Screening and diagnosis

The diagnostic process begins with your doctor taking your medical history and with a complete physical examination. Your doctor will ask whether you’re having symptoms such as head and neck pain, and will ask you to describe them. He or she will also check your fine-motor skills and swallowing ability.

If you have symptoms such as head pain, and the exact cause isn’t apparent to your doctor, you’ll likely undergo a magnetic resonance imaging (MRI) scan of your skull, which is the definitive diagnostic tool for Chiari malformation.

Using magnetic fields and radio waves, this test produces three-dimensional, high-resolution images of structural abnormalities that may be contributing to your symptoms. It can also provide pictures of the cerebellum and determine whether it extends into the spinal canal. A dye or contrast medium can be injected, and once it travels to your brain, it can enhance the MRI images. An MRI is a safe and painless test. Over time, repeat MRIs can be used to monitor the progression of this disorder.

Your doctor may use other imaging techniques as well. For example, your doctor may recommend a computerized tomography (CT) scan, which uses X-rays in conjunction with a computer to produce precise, sectional images of the bone tissue that surrounds the spinal column.

Complications

In some people, Chiari malformation can become a progressive disorder and lead to serious complications. In others, there may be no associated symptoms and no intervention is necessary. The complications associated with this condition include:

• Hydrocephalus. This accumulation of excess fluid within the brain may require placement of a flexible tube (shunt) to divert and drain the cerebrospinal fluid to another area of the body.
• Paralysis. This may occur due to the crowding and pressure on the spinal column. Paralysis tends to be permanent, even after treatment with surgery.
• Syringomyelia. Some people with Chiari malformation also develop a condition called syringomyelia, in which a cavity or cyst (cyrinx) forms within the spinal column. Although the mechanism connecting Chiari malformation with syringomyelia is unclear, it may be associated with injury or displacement of nerve fibers in the spinal cord. When a cavity forms, it tends to be filled with fluid and can additionally impair the function of the spinal cord.
• Death. When a child is born with Chiari malformation type IV, death is common, usually early in infancy.

Treatment

Treatment for Chiari malformation depends on the severity and the characteristics of your condition. If you have no symptoms, your doctor likely will recommend no treatment other than monitoring with regular examinations.

When headaches or other types of pain are the primary symptom, your doctor may recommend pain medication. Some people experience symptom relief with anti-inflammatory or pain-relieving agents such as indomethacin (Indocin). This approach may prevent or delay the need for an operation.

Reducing pressure by surgery
Surgery is the approach doctors use most often to treat symptomatic Chiari malformation. The goal is to stop the progression of changes in the anatomy of the brain and spinal canal, as well as ease or stabilize symptoms. When successful, surgery can reduce pressure on the cerebellum and the spinal cord, and restore the normal flow of spinal fluid.

In the most common operation for Chiari malformation — called posterior fossa craniectomy or posterior fossa decompression — your surgeon removes a small section of bone in the back of the skull, relieving pressure by giving the brain more room. The covering of the brain, called the dura, is then opened, and a patch is sewn in place to enlarge the covering and provide more room for the brain; this patch may be an artificial material, or it could be tissue harvested from your own leg or neck. The exact technique may vary, depending on whether a fluid-filled cavity is present, or if you have hydrocephalus. The operation takes about two to three hours, and recovery in the hospital usually requires two to four days.

Risks and follow-up
The use of surgery carries risks — the possibility of infection or problems with wound healing. Discuss the pros and cons with your doctor when deciding whether surgery is the best alternative for you. The operation is successful in most people, but if nerve injury in the spinal canal has already occurred prior to surgery, this procedure won’t reverse the damage.

After the operation, you’ll need regular follow-up examinations with your doctor, including periodic imaging tests to assess the outcome of surgery and the flow of cerebrospinal fluid.

Chiari malformation is a post from: by the pines