Chairi 1 and Ponticulus Posticus / Atlas relationship

[ParrotPal]

Hello. I would appreciate your help with info.  I am wondering if I should be evaluated for Chiari Type 1.  I have recently been seen by a bunch of doctors in S. Florida due to symptoms of dizziness (not spinning like vertigo - but balance, floating, lightheadedness), palpitations, new onset intractable migraine (which stopped after about 15 days), and severe tinnitis.  Other symptoms - hot and cold skin, but low temp, severe neck and back spasms and pain, visual disturbance.  It was the Chiropractor's notes  that let me to looking into this.  He said my xray shows Ponticulus Posticus.  This was after I had seen the Neuro, Cardio, the P.T. and the Neuro-ENT.  He said it is just something people are born with and mine is slight.  So I went to the Physiatrist (Physical Med and Rehab) that I have been seeing for many years.  This is the third exacerbation of symptoms (to the point of being an event) that I have had in less than 2 years, but have had on and off issues with all of the above symptoms for years before that.  The Physiatrist never heard of Ponticulus Posticus.  I think they use different terminology.  Anyway, the cardio gave me new DX of POTS/IST (postural orthostatic tachycardia syndrome / inappropriate sinus tachycardia) and put me on beta blocker for the palpitations.  The Neuro gave me new DX of migraines. The Neuro-ENT said everything is fine from his end, except the VNG Balance Test showed a mild deficit on the right side with no nystagmus.  The Physiatrist said exacerbation of fibromyalgia (a DX he has been using for years for me).

1. Does anyone know if there is a relationship between the Ponticulus Posticus (atlas part of skull and neck) and Chiari Malformation Type 1?  

2. What kind of doctor would I go to for an evaluation?

I have an appointment in two weeks at the Mayo Clinic in North Florida to see a Neuro, Dr. Cheshire, to be evaluated for dysautonomia due to the symptoms (all the doctors say they believe my problems is some kind of autonomic dysfunction that they can't do any further work-up on down here).  But now after hearing the Chiro about the Ponticulus, I wonder if it is Chairi.  The beta blockers have helped with the palpitations, but I do still have erratic dropping heart rate upon standing.  The "weird" balance issues still exist, the horrible tinnitus won't stop and cycles to higher and lower pitches (have noticed it over past few years).  I always thought I was having mini-sinus headaches and thought I was just cursed with a bad back, but I am concerned now about Chairi.  

Thanks so very much for your help and also for all the posts that everyone has made in this site to contribute to an important dialogue.

[n40066]

hi parrotpal!  welcome to our family!  i've never heard the term before myself, but googled it and see what selma is talking about.  i'm not a dr either, but it seems to me to be different from chiari.  it's more about the bone in the neck.  if you google it, you will find a couple of documents on it that make for interesting reading.  the only other thing i saw were a few study reports that had been done.  sorry i can't be much help on this one.  it's new to me!  wishing you the very best, though and do hope you will share with us what you find out!!  the mayo clinic is one of the best places you can be, so you are in good hands!
elizabeth

[selmaS]

Hi and welcome to the Chiari forum.

The reason ur dr may not be familiar with the term ponticulus posticus  could be he is more familiar with  arcuate foramen ....both terms r the same area......
The arcuate foramen is formed by a bony bridge (ponticulus posticus, or little posterior bridge) over a groove in the posterolateral margin of C1 known as the sulcus arteriae vertebralis. The vertebral artery and first cervical nerve normally travel within the sulcus arteriae vertebralis, and, when the ponticulus posticus is present, through the arcuate foramen.

The arcuate foramen is also known as as Kimmerle anomaly, foramen sagittale, foramen atlantoideum, foramen retroarticulare superior, and canalis vertebralis. It has been suggested that the ponticulus posticus comes about through ossification of the oblique portion of the atlantooccipital ligament, while others have found no age-difference to suggest an acquired process.

Migraines and HA's can originate from this area.

Not being a dr I have no idea how to put chiari and ponticulus together...other than when doing a decompression it is in the general area that is made larger to allow CSF flow......

Here is an article on the topic including chiari, however, I was having difficulties following the set up of the pdf file.....the article did not flow correctly and make sense or it was my chiari getting in the way...lol...http://www.lww.com/static/docs/product/samplechapters/978-0-7817-8436-8_Chapter%2019.pdf

"selma"