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Ask Dr. Arun Phophalia Your Own Question
Dr. Arun Phophalia
Dr. Arun Phophalia, Doctor (MD)
Category: Health
Satisfied Customers: 35011
Experience:  MBBS, MS (General Surgery), Fellowship in Sports Medicine
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My first MRI of brain showed chiari malformation 1 extending

Customer Question

My first MRI of brain showed chiari malformation 1 extending 9.5 mm inferior to the magnum.
One week later I had my c-spine MRI & it reads cerebellar tonsils extending 6 mm below the foreman magnum. Why the difference? What dose it mean
JA: Have you seen a doctor about this yet? What medications are you taking?
Customer: I'm seeing a neurologist on the 1st, I've only met with her PA once who ordered the test. I'm not taking any medication from her, she wanted test first. But I have horrible headaches every morning & ringing in my ears when I wake up
JA: Is the headache episodic or daily? And what about nausea?
Customer: Daily & yes I've been using otc motion sickness meds called Dramamine
JA: Anything else in your medical history you think the doctor should know?
Customer: I have Addison's Diease, I've been told
Submitted: 11 months ago.
Category: Health
Expert:  Dr. Arun Phophalia replied 11 months ago.

I am Dr. Arun and will be helping you today.

The brain protocol and cervical spine protocol are slightly different and thus there can be small difference of calculation because of the technique.

The headache may not be dependent on the herniation mass as sometimes massive mass herniation may be asymptomatic. Thus your neurologist may need to consider the other causes of headaches too. Even Addison disease is known to contribute to headache.

Most headaches are caused by following:

Tension-type headache

Migraine headache

Chronic daily headache

Cluster headache

Chronic daily headache is not a type of headache but frequent headaches of various kinds. Most people with chronic daily headache have migraine or tension-type headache as the underlying type of headache. Tension headaches are the most common type of primary headache. So probably this would be the first to be considered in the differential diagnosis of your headache also. A tension headache is a headache caused by tense muscles in the face, neck, or scalp. These headaches give a feeling of tightness around the head. The neck muscles can also become sore and tight. Tension headaches can be caused by staying in one position for a long time, such as reading, playing video games or using a computer.

Migraine headaches are the second most common type of primary headache. Cluster headaches are a rare type primary headache.

It is difficult to differentiate between migraine and tension type headache without an examination. There are other causes of headache also;

1) sinus headache

2) Medication overuse headache

3) Post trauma headache; occur after injury or accident.

4) Secondary headache; brain tumor.

Please feel free for your follow up questions.

I would be happy to assist you further, if you need any more information.

Thanks for using Just Answer.

Customer: replied 11 months ago.
It's not just a headache, I have a burning pain in my thoracic, clavicle area, it's always tight, I wake up with it an no has been going up and down puke around 120-169s
Expert:  Dr. Arun Phophalia replied 11 months ago.

The Chiari malformation can cause your all symptoms. But as discussed, many times symptoms can be due to concomitant medical issues and these need to be investigated. A big Hiatal hernia and associated acid reflux may also be associated and can cause burning pain chest and puking in morning. Treatment of acid reflux is;

1) antacids; Maalox

2) acid blocker; Prilosec

3) loosing weight, if overweight.

4) avoiding alcohol, citrus fruits and juices, chocolate, and tomato based products

5) avoiding large meals. Eat 5 small meals in a day.

6) wait three hours after the meal before you sleep.

7) elevate head end of the bed by 8 inches.

It is privilege assisting you.

Please let me know if you have further queries or unanswered questions.

Please consider a positive rating if this interaction has been satisfactory, as this is the only way we experts are credited and compensated for the time and work. You are not charged again for giving a rating.

Thank you.

Wishing you all the very best in life.

Expert:  Dr. Arun Phophalia replied 11 months ago.

May I help you more?
Feel free for further queries.

Customer: replied 11 months ago.
I've never had heartburn or do I have a hernia. I'm a nurse know the difference.. But chiari is new to me
Expert:  Dr. Arun Phophalia replied 11 months ago.

As we discussed; Chiari can be responsible for your symptoms. My apprehension was, Chiari 1 can be asymptomatic. Thus I gave you differentials. I cannot diagnose without examining you, But we can discuss the various possibilities to explain your symptoms. Being nurse, my task is easier as you understand the limitation of medical science which is not a perfect science. It is an art of possibilities and probabilities.

Your initial query was, why the difference between the two MRIs. And I answered it.

Best wishes,
It was my pleasure to help you.
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Expert:  Dr. Arun Phophalia replied 11 months ago.

Please let me know if I can do anything further for you.

Warm regards,

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