Case ReportChiropractic Care for Headaches and Dizziness of a 34-Year-Old Woman Previously Diagnosed With Arnold-Chiari Malformation Type 1
Introduction
Arnold-Chiari malformation (ACM) was first described in 1891 by Hans Chiari to refer to a group of syndromes consisting of different kinds of pathologic conditions of the posterior fossa hindbrain.1, 2 The most common type of all the ACMs is type 1, defined as a downward herniation of the cerebellar tonsils through the foramen magnum.3 Arnold-Chiari malformation type 2 involves displacement of the parts of the inferior vermis, pons, and medulla oblongata together with the elongation of the fourth ventricle; type 3 involves the entire cerebellum herniation into the cervical canal; and type 4 consists of cerebellar hypoplasia.
Arnold-Chiari malformation type 1 can vary greatly among individuals, ranging from asymptomatic to extremely symptomatic; however, associated symptoms tend to include headache, neck pain, and sensory changes, including weakness, dizziness, blurred vision, tinnitus, paresthesia, numbness and tingling, fatigue, difficulty sleeping, and other symptoms.4, 5, 6, 7, 8, 9, 10 Arnold-Chiari malformation is most often a congenital abnormality. Symptoms appear as the patient ages; it is more frequent in females than males with a 3:1 ratio, with an age range of 6 to 60 and a peak diagnosis age of 40 years.1, 11
A diagnosis of ACM type 1 is often suspected following physical examination and history. Patients often complain of headaches in the posterior-occipital area, radiating to the eyes with a pressure-type pain made worse with coughing, sneezing, or yelling.1, 10 Confirmation of ACM can only be made with imaging, most often made by cervical magnetic resonance imaging (MRI), which is the criterion standard; however, this is also seen on brain MRI, computed tomography, and cervical computed tomography.8 With the increased prevalence of MRI and decreasing cost, there has been an increase in the diagnosis of ACM.9
Current treatment of ACM varies greatly and is dependent on the discipline of the health care provider. One of the most widely accepted treatments for ACM type 1 is surgery. Several surgical approaches may be performed, including posterior fossa decompression surgery to remove a portion of the skull to correct any bone irregularity and create additional space for the cerebrospinal fluid to flow, electrocautery using high-frequency electrical currents to shrink the lower part of the cerebellum, and spinal laminectomy to remove part of the bones surrounding the spinal canal to increase the size and reduce pressure on the spinal cord and nerve roots. Surgery eliminates symptoms in approximately 50% of cases and reduces them in another 45% of cases.10 Conservative therapy is limited to medications and physical therapy. Chiropractic care is still controversial in the management of ACM. The purpose of this case report is to describe the chiropractic care of a patient with headaches and dizziness who was suspected to have ACM.
Section snippets
Case Report
A 34-year-old woman sought care for headaches, dizziness, photophobia, and temporary loss of vision aggravated by postural positions while bending forward. She would also experience dizziness while brushing her teeth, and she had unprovoked episodes of nausea with dizziness that would incapacitate her for 20 to 30 minutes. These episodes of nausea and dizziness would happen 4 to 5 days a week, 3 to 4 times a day depending on activity. She reported a prior diagnosis of ACM type 1 by MRI in 2005
Discussion
Some of the common signs and symptoms of ACM type 1 are headaches, neck pain, dizziness, tinnitus, paresthesia, numbness and tingling, fatigue, and difficulty sleeping, all of which are musculoskeletal complaints that are commonly seen in chiropractic practice. A patient with any of these symptoms will most likely undergo a conservative course of chiropractic care following a history and examination.
Tonsillar ectopia may also be responsible for headaches by mechanism of the mechanical
Limitations
As this is a case study, cause and effect cannot be suggested. It is possible that the patient may have improved on her own or in spite of care. With this case report, we were unable to control the environment of this patient. The patient may have unknowingly modified her activities of daily living, which in turn reduced her pain and lowered her outcome assessment scores. It is possible to have spontaneous resolution of ACM; thus, we cannot say that chiropractic care was responsible for
Conclusion
This case report describes a positive outcome of a patient who had headaches and dizziness and who was previously diagnosed with ACM type 1 symptoms.
Funding Sources and Conflicts of Interest
No funding sources or conflicts of interest were reported for this study.
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Cited by (2)
Spinning, hurting, still, afraid: Living life spaces with Type I Chiari Malformation
2019, Social Science and MedicineCitation Excerpt :The resulting pressure blocks the flow of cerebrospinal fluid, impairs functions of the cerebellum and leads to debilitating symptoms. These include dizziness, numbness, muscle weakness, impaired vision, headaches, impaired balance and coordination, nausea, problems swallowing, buzzing or ringing in the ears, hearing loss, vocal cord paralysis and sleep apnoea (see Figs. 2 and 3), many of which are often aggravated by movement and physical activity, and sometimes lead to insomnia and even depression (Doherty et al., 1995; Green, 2003; Greenlee et al., 2002; Milhorat et al., 1999; Ruff et al., 1987; Sergent and Cofano, 2014). There are four ‘types’ of Chiari Malformation.