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Dr. Bob
Dr. Bob, Neurologist (MD)
Category: Neurology
Satisfied Customers: 5275
Experience:  Neurology & Int Medicine (US Trained): 20 yrs experience
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Only. please), I was hoping you can help me with some

Customer Question

Only for Dr. Mark please)Hi Dr. Mark, I was hoping you can help me with some questions about chiari. I have it and decompression back 15 years ago when I was 23. I have since been doing alright. I still have had ocassional headaches and some numbness. Lately it has been worse. The headaches have been more severe with them coming on with coughing and the sides of my head and behind my eye. I have ocassional facial numbness lasting for a couples minutes. Brief arm and leg numbess which does not last long. My last brain Mri was good as far as I know about a 7 months ago. I have never had a CINE one though. I was examined by my nuerologist yesterday due to my lastest symptoms. last year my exam showed nothing unusual but this time she found mild clonus and I beleive less reflexes in my arms, some hypereflexia in my legs. She wants to investigate further and talked about possible ms. So I am getting another brain mri,C-spine and thorac. I do have constant low back pain but I also have some degenerative changes in my lumbar spine with scoliosis. I do have notable scoliosis but it has never changed. My neurologist is not a big believer in chiari symptoms. My My understanding is she thinks once it is fixed that's it. Where I had my surgery, with a competent experienced neurosurgeon, who had done many was such a different experience. Unfortunately we moved and he is retired. I did a bit of research and found quite a few article from surgeons who specialize in chiari, that these are some of the findings on their neuro exams. My question is: if my MRIs come back clean with no signs of ms, should I persue a referral back to a neurosurgeon that has done these. Do u agree that my symptoms could possibly be from my chiari,especially with my recurrence of symptoms? Thanks. All my previous mri never showed ms lesions.
Submitted: 1 year ago.
Category: Neurology
Expert:  Dr. Bob replied 1 year ago.

Hi there. Your requested expert has not picked up your question, so they have opened it to others. I can help you if you'd like.

Customer: replied 1 year ago.
Sure. That would be great.
Expert:  Dr. Bob replied 1 year ago.

My own opinion is that your current symptoms, if similar to those you experienced before your chiari surgery are likely related to it. The malformation, as well as the corrective surgery, means that the neurons are not entirely wired correctly, or could be hyper-excitable, and prone to misfiring. I would think it unlikely that you have been "blessed" with both chiari and MS. The odds are long against this. However, it is reasonable to get the repeat MRIs and take a look. It might also be reasonable to get an LP to check both your opening pressures, but to also look for oligoclonal bands.

Expert:  Dr. Bob replied 1 year ago.

That said, individuals with chiari are not immune from other types of headaches and neuropathies, of course. Your headaches and numbness/tingling could represent a type of migraine syndrome or migraine equivalent. I think a work up is appropriate...a reasonable treatment plan should follow.

Customer: replied 1 year ago.
I also had a NCS in May which show mild peroneal neuropathy on both sides one being slightly worse than the other with some sensory involvement. It was axonal as well. Arms were normal. Also had parasitic infection undiagnosed for a long time (trip to Mexico) and ended up with anemia. I just tested for vit b12 deficiency but had not see the results yet. Could b12 cause any of my symptoms.
Expert:  Dr. Bob replied 1 year ago.

Interesting. What was your doctors' take on that? Are you an athlete, or runner?

Customer: replied 1 year ago.
She really did not talk much about it. No I am not an runner. I am an OR nurse and we walk or run about 5km a day getting patients and supplies:) I was sick with the parasite for likely 5 months. Hopefully I can find out the b12 results early next week. My other question is can clonus (I believe it was mild) could be related to my chiari as a hav e read on some reports?
Expert:  Dr. Bob replied 1 year ago.

Bilateral peroneal neuropathies, if not from an underlying systemic disorder such as diabetes or B12 deficiency or a vasculitis, etc, is often from entrapment or compression of the peroneal nerves as they cross the heads of the fibulae and dive down into the tibialis anterior muscles. This is common in those who are on their feet a lot, or run, or do a lot of stair-climbing, for example. It would not be an expected finding in MS or chiari due to its bilaterality.

Expert:  Dr. Bob replied 1 year ago.

Did you have any follow up questions? Let me know if there is anything else I can do to be of help.

Regards,

Doctor-Bob

Customer: replied 1 year ago.

Hi Dr Bob, i had my MRI done today. I will not find out the results for a bout 5 days. I am posting a few images and was wondering if yo could tell me your opinion. I am being investigated for MS, already have chiari malformation with surgery.

Customer: replied 1 year ago.

Here is the brain MRI picture

Customer: replied 1 year ago.

Expert:  Dr. Bob replied 1 year ago.

A neuroradiologist will need to scroll carefully through all the images and compare findings from sequence to sequence. This is a rather laborious process requiring a high level of specialized training. That said, I don't see any obvious white matter lesions jumping out of these few images. There do appear to be some post-surgical changes/scar tissue?? in the region of your surgery/chiari malformation which might be a factor in your symptoms. Just be sure to ask your doctors about this if the neuroradiologist does not specifically address them in his or her report.

Customer: replied 1 year ago.

These imagines are with contrast.

Expert:  Dr. Bob replied 1 year ago.

Thank you for the additional image. There is a lot of information contained in an MRI and this should help your doctors make a more accurate diagnosis. While I don't see any obvious signs of MS, the diagnosis is a clinical one...with support from MRI and LP.

Customer: replied 1 year ago.
Hi Dr Bob. I found out my results today. No ms lesions and chiari is fine but it shows a questionable hemangioma at c2. They want a follow up ct scan. Does this sound correct? Are they just being cautious?
Expert:  Dr. Bob replied 1 year ago.

Not likely...they are probably getting the CT because the hemangioma is in the bone and CT shows bony detail better than MRI. Do you have any prior studies available (either MRI or CT) with which to compare this finding?

Customer: replied 1 year ago.
No I do not. Is there a small chance that this hemangioma is causing a myelopathy thus causing my symptoms?
Expert:  Dr. Bob replied 1 year ago.

Don't think so. It appears to be in the C2 vertebral body. The cord at this level looks normal in the few images you have provided.