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Cerebellar tonsillar ectopia
My daughter had an mri done this past Friday. The impression of the MRI stated that she had cerebellar tonsillar ectopia. She has a minimal downward extension of the cerebellar tonsils compatible with tonsillar ectopia. What does this mean? Is this serious? What is the treatment?
I am 40 years old and have hemiplegia on my left side, my left foot is paralysed causing foot drop and cannot feel half of my face. I suffer from daily painful migraines that have left me disabled and my Dr says I am post stroke but I want to know what this means. Please help!
Reason for Exam: COMMON MIGRAINE(WITHOUT AURA) CHRONIC WITH INTRACTABLE MIGRAINE
Signs and Symptoms: prev mri 4/22/14.
Additional Comments: pt states left side weakness and foot drop since Jan 2015 after bad migraine attack
MRI HEAD WITH AND WITHOUT INTRAVENOUS GADOLINIUM CONTRAST
TECHNIQUE: Multiplanar MR imaging of the head was performed with and without intravenous gadolinium contrast.
COMPARISON: 04/22/14
FINDINGS: There is no hemorrhage, mass effect or extra-axial fluid collection. There is normal gray-white differentiation. No white matter
abnormality is seen. No abnormal enhancing lesions are seen in the brain. There is cerebellar tonsillar ectopia, but the cerebellar tonsils measure
less than 5 mm below the foramen magnum. There is crowding at the foramen magnum. The orbits are clear. Mild ethmoid mucosal thickening is noted.
There is a Tornwaldt cyst in the nasopharynx. There are normal carotid and vertebrobasilar flow voids. There is no acutely restricted diffusion.
IMPRESSION:
Mild cerebellar tonsillar ectopia. This causes crowding at the foramen magnum.
Otherwise, normal MRI of the brain.
Mild mucosal thickening in the ethmoid air cells
Reason for Exam: COMMON MIGRAINE(WITHOUT AURA) CHRONIC WITH INTRACTABLE MIGRAINE
Signs and Symptoms: prev mri 4/22/14.
Additional Comments: pt states left side weakness and foot drop since Jan 2015 after bad migraine attack
MRI HEAD WITH AND WITHOUT INTRAVENOUS GADOLINIUM CONTRAST
TECHNIQUE: Multiplanar MR imaging of the head was performed with and without intravenous gadolinium contrast.
COMPARISON: 04/22/14
FINDINGS: There is no hemorrhage, mass effect or extra-axial fluid collection. There is normal gray-white differentiation. No white matter
abnormality is seen. No abnormal enhancing lesions are seen in the brain. There is cerebellar tonsillar ectopia, but the cerebellar tonsils measure
less than 5 mm below the foramen magnum. There is crowding at the foramen magnum. The orbits are clear. Mild ethmoid mucosal thickening is noted.
There is a Tornwaldt cyst in the nasopharynx. There are normal carotid and vertebrobasilar flow voids. There is no acutely restricted diffusion.
IMPRESSION:
Mild cerebellar tonsillar ectopia. This causes crowding at the foramen magnum.
Otherwise, normal MRI of the brain.
Mild mucosal thickening in the ethmoid air cells
I have CTE and have been going to a chiropractor to realign the frontal magnum and bone below it. Tho there isn't much empirical evidence (my MRI and measurements are being sent to a doctor in NY/ Maryland who is collecting such). They feel very hopeful that the body will slowly heal itself as the brain has room to move back. I wish you well on your journey, but also wish people would look into alternative medicine before allowing butche...doctors to cut into the neck/skull/brain...a prospect which is anything but encouraging. (no offense to doctors as they mean well...just insurance companies winning here).
What are some of the effects on the rest of the body. I have this disorder/malformation and what to know if these other things are new symptoms or something else. Does this effect any other conditions like digestive? I know that it effects the muscular system through the weakness.
Hello Dr. Sharma I wish you can guide me. I will like to know what is the diagnosis for the next impression: 1. Minimal cerebellar tonsillar ectopia as described extending close to 8mm inferior to the inferior border of formamen magnum. 2. Ventricular system in preserved. 3. No enchancing lesions. I will like to know if this can be considered chiari syndrome or malformation? I will send you my e-mail address, (***@****) please I will like to know how can I help my daughter and what are the limitations for this condition? I can not go to a neurologist because in my country we are having problem with the health card. I'm a single mother, with disability, unemployed and have no help from no one. My daughter is only 18 years old and she is in the university. The little I have is not enough to help her, but I desire to help so she can succeed in life, but I need to know what she have?, what are their limitations and how we can I help, or where or who I have to refer for this condition.
1 Comments
DEFINITION:
In the back of your brain there are tonsils, called cerebellar tonsils, that can descend through the base of the skull (foramen magnum). If there is only a slight tonsillar protrusion thru the foramen magnum and the patient does not exhibit typical symptoms of Chiari, the patient may be diagnosed as having cerebellar tonsil ectopia – sometimes considered a milder form of Chiari malformation. A final clinical diagnosis is made only after a neurologic exam and detailed history is taken.
Chiari malformation is a congenital anomaly of the cerebellum and brainstem. Although four types have been described, types I and II are more common. Type I is identified by protrusion of cerebellar tonsils through the foramen magnum, down to the C1 or C2 level of the cervical spine. It may or may not be associated with syringomyelia/hydromyelia. Type II is the most common type of Chiari malformation, always associated with myelomeningocele. The remainder of this summary describes Chiari type I malformation.
SYMPTOMS:
Presentation usually begins in adulthood, from ages 20 to 50 years. The most common symptoms are headache or neck pain, aggravated by coughing, sneezing or extension of the head and neck. Other symptoms may include imbalance or distorted vision. Less common are altered sensation or weakness of the arms and/or legs, which are typically associated with hydromyelia.
TESTING:
MRI scan of the brain and/or cervical spine is the diagnostic test of choice to confirm Chiari malformation. Hydromyelia/syringomyelia can also be identified by MRI scan. Various degrees of Chiari malformation or tonsillar ectopia can be identified on the MRI scan.
TREATMENT:
The only effective treatment for Chiari malformation is surgery. The most common surgical procedure is suboccipital craniectomy to decompress the cerebellar tonsils (surgical opening of the bony compartment of the back of the head) with laminectomy of C1 and/or C2 to decompress the cervical spinal cord. Opening of the dura (lining of the brain and spinal cord) with dural grafting to expand the cranial and upper cervical spine space completes the procedure. Sometimes the surgeon will elect to not open the dura. The procedure is performed under general anesthesia and usually lasts two to three hours.
The recovery period requires a one-to-two-day stay in the intensive care unit for neurologic observation. This is followed by another one-to-three days in a general hospital room to complete hospital recovery and resume independent self-care activities. The total hospital stay averages three to five days. The postop pain is moderate and may be associated with nausea for the first 24-48 hours. These symptoms are effectively controlled by medications administered by the nursing staff.
Outpatient recovery usually takes four to six weeks. During the first two weeks, no driving is allowed. A return to an office job or sedentary work can resume approximately four to six weeks after surgery. Full physical activity can be resumed in approximately two to three months.
In the back of your brain there are tonsils, called cerebellar tonsils, that can descend through the base of the skull (foramen magnum). If there is only a slight tonsillar protrusion thru the foramen magnum and the patient does not exhibit typical symptoms of Chiari, the patient may be diagnosed as having cerebellar tonsil ectopia – sometimes considered a milder form of Chiari malformation. A final clinical diagnosis is made only after a neurologic exam and detailed history is taken.
Chiari malformation is a congenital anomaly of the cerebellum and brainstem. Although four types have been described, types I and II are more common. Type I is identified by protrusion of cerebellar tonsils through the foramen magnum, down to the C1 or C2 level of the cervical spine. It may or may not be associated with syringomyelia/hydromyelia. Type II is the most common type of Chiari malformation, always associated with myelomeningocele. The remainder of this summary describes Chiari type I malformation.
SYMPTOMS:
Presentation usually begins in adulthood, from ages 20 to 50 years. The most common symptoms are headache or neck pain, aggravated by coughing, sneezing or extension of the head and neck. Other symptoms may include imbalance or distorted vision. Less common are altered sensation or weakness of the arms and/or legs, which are typically associated with hydromyelia.
TESTING:
MRI scan of the brain and/or cervical spine is the diagnostic test of choice to confirm Chiari malformation. Hydromyelia/syringomyelia can also be identified by MRI scan. Various degrees of Chiari malformation or tonsillar ectopia can be identified on the MRI scan.
TREATMENT:
The only effective treatment for Chiari malformation is surgery. The most common surgical procedure is suboccipital craniectomy to decompress the cerebellar tonsils (surgical opening of the bony compartment of the back of the head) with laminectomy of C1 and/or C2 to decompress the cervical spinal cord. Opening of the dura (lining of the brain and spinal cord) with dural grafting to expand the cranial and upper cervical spine space completes the procedure. Sometimes the surgeon will elect to not open the dura. The procedure is performed under general anesthesia and usually lasts two to three hours.
The recovery period requires a one-to-two-day stay in the intensive care unit for neurologic observation. This is followed by another one-to-three days in a general hospital room to complete hospital recovery and resume independent self-care activities. The total hospital stay averages three to five days. The postop pain is moderate and may be associated with nausea for the first 24-48 hours. These symptoms are effectively controlled by medications administered by the nursing staff.
Outpatient recovery usually takes four to six weeks. During the first two weeks, no driving is allowed. A return to an office job or sedentary work can resume approximately four to six weeks after surgery. Full physical activity can be resumed in approximately two to three months.
MEDICAL PROFESSIONAL
Hi there. Cerebellar herniation or tonsillar herniation is when the cerebellar tonsils move downward through the foramen magnum causing compression of the lower brainstem and upper cervical spinal cord as they pass through the foramen magnum. Tonsillar herniation of the cerebellum is known as a Chiari malformation. There are three types of chiari malformation and can be incidental findings. Cerebellar ectopia is a term used by radiologists to describe cerebellar tonsils that are low lying but do not meet the radiographic criteria for definition as a Chiari malformation.
Treatment involves removal of the etiological mass and decompressive craniectomy. Brain herniation can cause severe disability or death. The prognosis for a meaningful recovery if visible on CTscan is poor. The patient may become paralysed on the same side as the lesion causing the pressure or damage to parts of brain caused by herniation may cause paralysis on the side opposite the lesion.
Damage to the cardio respiratory centers in medulla oblongata will cause respiratiory and cardiac arrest.
Consult your neurologist immediately for detailed evaluation. Take care.
Treatment involves removal of the etiological mass and decompressive craniectomy. Brain herniation can cause severe disability or death. The prognosis for a meaningful recovery if visible on CTscan is poor. The patient may become paralysed on the same side as the lesion causing the pressure or damage to parts of brain caused by herniation may cause paralysis on the side opposite the lesion.
Damage to the cardio respiratory centers in medulla oblongata will cause respiratiory and cardiac arrest.
Consult your neurologist immediately for detailed evaluation. Take care.
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