My Life Living With Chiari I Malformation

2012-01-24T21:37:00.000-08:00

POWERFUL INFORMATION FROM A CHIARI SPECIALIST!
Dr. Oro, Thank you for being such a great Doctor! You give me faith and hope that goodness & world class excellence still exists within the medical community in this country.

Why is chiari malformation commonly misdiagnosed and misunderstood?

2012-01-24T21:27:00.000-08:00

OPTHAMOLOGIST APPT

I saw the ophthalmologist today for my LEFT eye twitching, laziness, and palsy.

He found a scar on the nerve of my left eye, right where my eye was hit, during the injury a few years ago, and he said it's completely healed up.
He also mentioned that he believes I have peripheral neuralgia, and is referring me back to the neurologist. He also said that I should be seeing a Chiari Expert Neuro Surgeon, not just a neurologist.
He set me up for additional tests, like a field test for starters.
I felt good about the appointment. My vision is a PPO.
The Dr. said he knew what CM was.That was kind of cool!
1) I don't drink or smoke
2) I don't have diabetes
3) I eat really well, low sugar, balanced, organic, seafood diet and take supplements to give my body extra support.

WHAT IS PERIPHERAL NEURALGIA?

Peripheral neuropathy isn't a single disease, but rather a symptom with many potential causes. For that reason it can be difficult to diagnose. Your doctor will need to determine where the nerve damage is and what's causing it.
Diagnosis usually requires:

A full medical history. This includes your symptoms, your lifestyle, exposure to toxins, drinking habits and a family history of neurological disease.
Neurological exam. This may include checking your tendon reflexes, your muscle strength and tone, your ability to feel certain sensations, and your posture and coordination.
Physical exam. Your doctor will likely do a complete physical exam.

Your doctor may order tests, including:

Blood tests. These measure various levels, such as vitamin and blood sugar levels; and bodily functions, such as thyroid, liver and kidney.
Imaging tests. Your doctor may request a CT scan or MRI to look for herniated disks, tumors or other abnormalities.
Nerve function tests. These may include electromyography — which reads electrical activity in your muscles to determine if your weakness is caused by muscle damage or nerve damage — and nerve conduction studies — which assess how your nerves and muscles respond to small electrical stimuli, generated by a probe and measured by an electrode placed along the nerve's pathway.
Nerve biopsy. Your doctor may recommend this procedure to try to determine what's damaging your nerves. A small portion of a nerve is removed and examined for abnormalities.

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Other disorders can cause the symptoms seen in CMI.

Patients suffering from the CMI often have multiple symptoms. However, each symptom can be caused by other disorders. After the patients symptoms are determined and a neurological exam is performed, the physician considers the multiple disorders that may cause similar symptoms and findings. This is called the differential diagnosis. The differential diagnosis of patients evaluated for the CMI is large and includes disorders such as:

Chronic fatigue syndrome
Cluster headache
Degenerative cervical disc disease
Fibromyalgia
Hydrocephalus
Lyme disease
Migraine
Multiple sclerosis
Occipital neuralgia
Peripheral neuropathy
Pseudotumor cerebri
Post-concussion syndrome
Posterior fossa arachnoid cyst
Psychiatric disease
Sleep apnea
Spinal CSF leak
Vasculitis

2012-01-24T12:20:00.000-08:00

Patience To Accommodate My Horribly Bad Luck;
After contacting everyone regarding the errors on my MRI, I feel like things may change, but I am not sure. I am on a mission for the truth today. I can't take my bad luck out on others, but I did ask if a neuroRAD would be reading my MRI when I signed in, and they said yes. So that's not my fault they had a regular radiologist read it. It seems like the radiologist just didn't have the experience in measuring Chairi Malformations as I expected, so they are going to have a NeuroRAD read it, speak with my Doctor, and file an addendum.
The possibility of the prior MRI being inaccurately read was raised. I insisted that I trust my previous outside HMO Doctors, and that it was a neuroradiologist who read my original MRI, so I doubt they made a mistake in sizing up the Chiari. Anyway, if they had, it certainly wouldn't be a 5mm error! I am learning that everything that can go wrong for me does, so this means it will go wrong for those trying to help me. As of today, I am going to work hard on trying to remain composed, calm, cool, and collected, no matter how frustrated I get.
Seriously, this is MY life.

2012-01-23T23:14:00.000-08:00

Today I am going to rant about my frustration with the HMO!
So I get my report back. Someone please tell me how it is possible that an HMO network of Doctors can RE-WRITE your medical history with COMPLETE disregard for previous MRI reports?

RECAP; So as you know, and maybe I should post it, I have a previous diagnosis where an MRI found a 5mm Chiari Malformation in 2000. I was on a PPO then when I got that MRI done but I went out of network. Ive dealt with headaches my whole life, and always wondered why.
If you also recall, when I went for my NEW brain MRI last week, I asked them if I could pay cash for a neck one also, since I knew my neck has some issues as well.

Anyway, so I get both reports in hand, and I can clearly see that the neck MRI report was honest, and contained all past and current disorders within my cervical zone. It explained SOME of my pains, and current ailments.
Now I get to read the brain MRI. :/ It starts off by saying that my "history" was "headaches for months". Where did that come from???? I've had headaches for my whole life. They didnt even question me when I went in, only had me fill out some basic form, and she said he'd interview me once I went in to do the MRI, which NEVER happened!
Next it says under "History" that Ive never had any mri's of the same area. :0
I gave the sign in person my previous MRI report and it was put it in a folder. Did the radiologist fail to look into my folder? Ok, no worries, people make mistakes right?
:/
I am already beside myself at this point. I need help, seriously. Help from other chiarians!
Allow me to remind you that in 2009 the same hmo network of doctors sent me for a mri of my spine b/c I had pain since the injury, and it came back with "mild levo scoliosis" but NO bulged disks, yet I knew I had them, because NEVER in my life would scoliosis cause the pain that I had and still have today. anyway, so I sent the same mri cd to another neuroradiologist, in another state to avoid any insurance influence, and it came back positive for 4 bulged disks ranging from 1mm to 3mm. Now that's after 2 yrs of PT, imagine what size they were right after the injury? The pain this HMO has put me through is ridiculous, seriously. Someone please help!

Now back to the current HMO generated MRI of the Brain. Keep in mind, we did this MRI in the supine position, & I found out this weekend that it should have been done in the upright position. So I am combing through it, and I get to the part where it says "impression". All of you chiarians know what this means. And well, to sum it up, he actually says that there is a (chiari)herniation but it's not past the foramen magnum, so it's not technically a chiari by his measurement. In his own medical terms of course. I think I may just post both the previous MRI report, beside the current HMO one, for you to compare. He's either 1)inexperienced in the measuring of a chiari (which is common) or 2) He's sitting in someones pocket. I pray & believe it's the former. I had a good feeling about this imaging center at the moment I walked in the door. Other than them being in a little bit of a rush, they were very nice, and polite to me. Keep in mind that Chiari Surgery is very expensive and nobody's going to want to pay for it.

It is however a bit amusing to think that my brain must have grown legs and crawled its ass end back up into my head, and above the foramen magnum over the past 12 years, yep, all the while my symptoms poured in, and worsened with time, post injury. Well, it's a hindbrain right? Maybe it does have legs after all?? Somehow it raised itself up a MINIMUM OF 5 MM's!! Or the previous report done by a neuroradiologist was off by 5 mm? I think not.The person who read this newest MRI was regular radiologist. One might expect that a neuroradiologist would be the choice for reading a BRAIN Mri.

2012-01-21T23:44:00.000-08:00

Back Pain: I've had the worst back pain in the lower lumbar, up to thoracic area, since before my last ER visit approx. Nov 2011. They did a CT scan, and said that they couldn't see anything wrong with any of my organs, and gave me a strong antibiotic for what they thing "could be" a kidney infection. I took the antibiotics, and some of the pain faded ,but the pain my my back, that caused vomiting, returned not long after I destroyed my immune system with a round of extremely strong antibiotics. I've been dealing with it for about 4 months now. I keep telling my primary care Dr. but he's just prescribing me pain pills. It hurts to bend certain directions, and after reading about tethered cord syndrome, and how so many ER Dr's fail to recognize it, as well as chiari malformations, I must find a Dr. that specializes in CM's. This is just ridiculous. I am fed up.
I like this resource for reading up on the diagnosis of Chiari Malformations.
Headaches & Chiari

2012-01-20T22:14:00.000-08:00

My newest MRI was done yesterday. So when I arrive at my appointment, I get to thinking about how the Dr. should have ordered an MRI of my cervical spine. As per the previous MRI, the CM is supposed to be monitored with MRI and contrast. I asked if I could pay cash to do the neck (cervical) MRI while I was there, and they gave me an offer I couldn't refuse, so we did both. YaY!
I took my cd home that day, and await the report now. Upon viewing my cd, I can clearly see my chiari here but based on what I've read, it should have been done in the upright position. Since Chiari's don't reverse and crawl back up into your head, it has to be a minimum of 5mm as per the last report. Monday I should have my results. I see some other questionable things in my neck and brain mri both, but I wont comment since I am not a radiologist. I'll just have to wait!!! We'll see what turns up on the report.
UPRIGHT MRI
:)
NOTICE BELOW ON THIS PERSONS MRI THAT IT SAYS "UPRIGHT"? THAT'S BECAUSE you'll get a more accurate reading when it's done in an upright position. MY MRI WAS done in the supine position! WHOOOO HOOOO GOTTA REDO IT NOW.

Here is an image of a brain that is not have a Chiari Malformation. See the right lower area that resembles ocean coral? Note how it's not all crowded and there's plenty of spinal fluid around it? It sits much higher up than mine does because it's not herniated.

2012-01-18T23:18:00.000-08:00

Screen Actors Guild brings together performers with disabilities......
http://www.sag.org/tri-union-summit-brings-together-performers-disabilities-and-industry-executives

Since I am a member of SAG, I found this worthy of posting. I wonder how much work a person who's disabled with a "chiari I malformation" will get. Maybe they'll find ways to incorporate the "trouble finding words" into the script. If so, I should hit it big! Lmao!!!

2012-01-18T22:22:00.000-08:00

I've never been so excited in my life to get an MRI. Tomorrow I will get my first MRI since the original one back in 2000! It took a lot of fighting with my hmo gp to get it done. They seem to prefer to wait until you're practically a vegetable, paralyzed, and/or tweaking out before they will give you the tests that you need to begin the path of curing the illness rather than treating it's symptoms. In an effort to ease my pain about having this disorder, I've made bets with friends on the size of the herniation it is upon results of tomorrows MRI. There's a prize valued at 160.00 for the person who guesses the closest!
After reading about the syrinx, me thinks that the neuro should have ordered the neck be done also. Am I correct? He should be checking for a syrinx as well, especially since that can paralyze a person.
:/ Okay, I am going to beg them tomorrow to get as much of my neck as they can and will.
I am a little nervous about tomorrow because I have had a itchy throat for 5 days now. I have no idea why or what it is. I cough a little but nothing comes up, I don't feel like I am sick. Nyquil doesn't work to stop the cough either. I hope not to cough during the MRI. YIKES!!

Jan 19, 2012
Brain MRI

My Life Living With Chiari Malformation I

2012-01-14T18:23:00.000-08:00

First and foremost; I have not collected on, nor am I in any law suits surrounding my chiari malformation and it's symptoms. I am here writing this to help others, and hope to prevent them from going through the nightmare that I have since I suffered a closed head injury that made my practically Asymptomatic (no symptoms) Chiari I Malformation, become highly symptomatic.

AGE 0-10: Was I born with it, or did the Chiari Malformation itself occur as a result of a car accident at the age of 10 where I was diagnosed with "whiplash injury"? But they did nothing for it except send me home with a neck brace for a week, then on check up said I was fine. Well, I only had headaches that began after the accident, that was my only symptom until a second insult/ injury occurred over 20 years later.
SYMPTOM LIST: HEADACHES-Relieved with Bayer

AGES 11-20 (later)
SYMPTOM LIST: Occasional Headaches-relieved with (1) Advil only. Take once and it's gone. May get one or two headaches in a month, then not another for 3. Depended on exertion. The running would guarantee a headache every time. So I quit doing things that caused headaches, except horseback riding, it was my job at age 12 to exercise & train horses, & I sometimes found this difficult to do without getting a headache. Aggravated when horseback riding, running, jogging, volleyball, baseball. Workouts in the gym are strong and solid. Body is solid and symmetrical.
NO PMS-NO CRAMPS-NO NOTHING from that.

AGES 21-29 (later)

SYMPTOM LIST: Mild Levo-Scoliosis. Headaches-relieved with (2)Advil. Take once, headache is gone. Headaches maintained the same stance. Occasional. Sometimes I'd do well and not see one for a few months. Seeing Chiropractor on occasion to keep everything moving and aligned. Headaches aggravated with normal crashes on wake board, running, jogging, if someone hits me in the head with a pillow or I change pillows or sleep on a real bad bed.
NO PMS-NO CRAMPS-NO NOTHING from that.

AGEs 30 & Up:
PRE HEAD INJURY SYMPTOM LIST: Mild Levo-Scoliosis. Headaches occasional. Small change, sometimes having to take advil more than once to relieve the headache but not real bad. Tried BCP and had a migraine, so I stopped that right away. One episode of facial paralysis (Bells Palsy)

POST HEAD INJURY SYMPTOM LIST: (C)=current-past two months.
wake up choking, couldn't breathe, need water to relieve (c)
dizziness (c)
fatigue
nausea
scoliosis (c)
pain in back of neck and head(c)
headaches lasting 3 days and taking advil every four hours to relieve, sometimes not working.
Migraines(c)
clumsiness(c)
memory loss(c)
restricted movement in neck, hip and back(c)
intolerance for bright light in house or outdoors(c)
pressure in neck(c)
pressure behind eyes(c)
neck & back spasms-(as per mri report)(c)
insomnia-rarely
ringing in the ears (occasional)
pain in some direction of movement (back mid to lower) and neck.(c)
intolerance to loud confusing noises. Kids and the TV will send me out the door!(c)
hand tremors (2011-2012)(c)
sinus (mucos problems) (as per mri)(c)
decreased muscle tone all over but mostly on left arm(c)
pressure in ears as if I went up a mountain (last a few minutes to a few hours)(c)
nausea and vomiting from pain in neck, abdominal pain, back pain.(c) ER for this twice!
difficulty reading, focusing on text and comprehension(c)
burning sensation in left arm and shoulder-esp during workout (2010-2012)
Menstrual problems -NEW cramping
Frequent urination at night (c)
Colonoscopy reveals nothing abnormal
Cystoscopy reveals nothing abnormal
OBGYN says that the tiny uterine fibroid is way to small to cause the above problems and it must be something else.
smelling sudden strong smells(c)
hurts head to cough(c)
loss of words (c)
slurred speech (2012)(c) (friends pointing it out)
Having to RE-type a LOT of what I write here b/c of so many "hitting the wrong keys". (c)

Other than headaches, I don't know how to express how healthy I was prior to this injury. I did every sport under the sun. Ski, surf, snow, water, jog, basketball, hiking, raquetball, rollerblading, horseback riding, etc. I did it all and at the end of the day, if I were REALLY hard on myself, as in triple flips, and crashes on my wakeboard, I'd have a headache. I never had a primary care Dr. in my life, saw a chiropractor on occasion, because I heard that they were good for athletes like myself. Did the yearly obgyn check ups, had one cold, and never had the flu. Needless to say my trips to any type of Dr. other than my chiropractor & routine obgyn could be counted on one hand. Suspicious of my headaches, my chiropractor ordered a random brain MRI in 2000. It revealed that I had a 5mm Chiari Malformation. It explained my occasional headaches that weren't associated with PMS. I've never had PMS. At the time I was told that I had a CM, I had no idea what that meant, what would come, and how it would change my life, if I didn't protect my head like fort Knox. In fact, I threw the mri report into some file that ended up archived, and almost never again found. The head injury occurred a few years ago, and the pain was immediate so I went directly to the ER. While at the hospital I asked for a head mri & pointed at my head. I was in a fog and I hurt all over but mostly in the head and upper cervical area. At that point "chiari" was long forgotten, nor was I in any condition to remember it, as I was suffering from a concussion to name one of several injuries in that accident. The Doctor who hardly spoke English gave me a worthless Ct scan, & I had to pay for it! Over the course of a few years that ER visit was followed by over 30 doctors ranging from gp, chiro, neuro, ortho, gastro, urologist, pt, physio, psychologist, holistic, herbal, acupuncturist, ophthalmologist, and so on. It's fair to say that my life was changed forever! Finally, and after some of the fog cleared, it hit me. I had a brain mri in the past, and thought to myself maybe that "chiari" thing means something. the question was, could I find it. I searched through my storage, deep into archives, and found that magical paper.

Thanks to the internet and the education I've received from studies online, as well as other people's stories, I am very enlightened, but afraid. Why? Well this disorder I have Called a Chiari I Malformation, which has been overlooked, and under-treated by my Doctors, could at any time lead to quadriplegia. As IF dealing with it's symptoms alone wasn't enough??

After a month of eye twitching, 6 mo's of left arm weakness, 4 years of fingers tingling, 4yrs of walking left into walls (off and on), this entire week of severe headaches, a life of headaches, dizziness, and vomiting from pain, I wonder how much longer the HMO is going to make me wait for the brain MRI to monitor it????????

I feel that the biggest challenge I seemingly face in this battle, is how I tend to look "good", "healthy", "pretty", and "normal", so the first thing Doctors do when they see me is relax, and half listen. It's their apathetic behavior that has led me to silently suffer for as long as I have!!!

Here is a diagram of the brain with a Chiari I Malformation. This is what I am faced with.

While it is generally believed that Chiari malformation occurs at birth, recent scientific research has shown that this condition, which may be asymptomatic, can become symptomatic due to trauma. Also, there is a body of literature that recognizes that Chiari malformation may become acquired as opposed to congenital.

The leading study on the effects of trauma and Chiari malformation was published by Thomas H. Milhorat, M.D. et al in a study of 364 symptomatic patients.3 In this study, 364 symptomatic patients were evaluated (275 female and 89 male). The study found that Chiari malformation I is a disorder of the para-axial mesoderm that is characterized by underdevelopment of the posterior cranial fossa and overcrowding of the normally developed hindbrain. Clinical manifestations of Chiari malformation I were related to cerebrospinal fluid disturbances which were responsible for headaches, pseudo tumor-like episodes, endolymphatic hydrops, syringomyelia, hydrocephalus and direct compression of nervous tissue.

In this study, 25 percent of the patients cited trauma as the precipitating factor. The most common mechanisms were whiplash injuries and direct blows to the head and neck, which raised the possibility that certain types of trauma accentuate tonsillar impaction or result in subarachanoid hemorrhage that destabilizes a marginally compensated CSF system.

This persons MRI shows a syrinx. Syringomyelia, often referred to as SM, is a chronic disorder involving the spinal cord. The condition occurs when cerebro-spinal fluid (normally found outside of the spinal cord and brain) enters the interior of the spinal cord, forming a cavity known as a syrinx. This syrinx often expands and elongates over time, destroying the center of the spinal cord. As the nerve fibers inside the spinal cord are damaged, a wide variety of symptoms can occur, depending upon the size and location of the syrinx.
There are two major types of SM. In most cases it is related to a congenital malformation involving the hind-brain (cerebellum) called a Chiari Malformation. This malformation occurs during fetal development and is characterized by downward displacement of the lower part of the brain (cerebellar tonsils) beneath the foramen magnum, into the cervical spinal canal. This displacement blocks the normal flow of cerebrospinal fluid. When normal flow is obstructed, a syrinx can form in the spinal cord. Not all patients with Chiari Malformations will develop a syrinx, however.
SM can also occur as a complication of trauma, meningitis, tumor, arachnoiditis, or a tethered spinal cord. In these cases the syrinx forms in the section of the spinal cord damaged by these conditions. As more people are surviving spinal cord injuries, more cases of post-traumatic SM are being diagnosed as the syrinx can form years after the trauma.

SYMPTOMS of a syrinx: The symptoms I have had over the past year are in red.

Symptoms develop slowly over time, but can come on suddenly after a fall or minor trauma. Sensation may be affected first. Some common symptoms include:

Loss of sensitivity to hot and cold
Numbness and tingling
Bowel and bladder function may be affected
Scoliosis
Pain
Muscle weakness
Spasticity
Paralysis (in severe cases, quadriplegia) IN MY case it was the left side of my face, as in BELL'S PALSY.

Scoliosis may be the only symptom in children. Often people with scoliosis undergo spinal MR imaging because of an atypical left-sided thoracic curve.
Many individuals suffer from chronic pain and some will develop neuropathic pain syndromes. This type of pain is difficult to treat. A large percentage of people have headaches which can be severe.

TREATMENT:
The first step after diagnosis is finding a neurosurgeon who is experienced in the treatment of SM. Finding a specialist is highly recommended. Surgery is the only viable treatment for SM, but not all patients will advance to the stage where surgery is needed. Evaluation of the condition is often difficult because SM can remain stationary for long periods of time, and in some cases progress rapidly.
Treatment is aimed at restoring the normal flow of spinal fluid. In persons with Chiari and SM, a procedure known as a posterior fossa decompression may be recommended. This procedure allows the cerebellar tonsils to move into a normal position, restoring the normal flow. After this procedure the syrinx will often reduce or resolve on its own. This can take months and may never completely collapse the syrinx. Some patients may require repeat surgeries. The most important consideration in deciding to undergo surgery is the severity of symptoms and overall quality of life issues.
In syrinxes associated with other causes, the surgical treatment is also aimed at restoring normal physiology and flow of spinal fluid. This might involve a bony spinal decompression, removing a tumor or scar tissue. In cases of tethered spinal cord, a surgical procedure is used to release the tension on the cord, allowing it to return to its normal position.
In rare cases, a shunting procedure may be necessary. This involves inserting a tiny tube into the syrinx which drains to a cavity outside of the spinal column. Shunting procedures are associated with certain risks and shunts frequently become clogged or dislodged. Repeated surgeries may be necessary.

THE DANGERS OF MIS-DIAGNOSIS:

The single most significant risk in misdiagnosing CMI is the subsequent formation of syringomyelia which often results in irreversible damage to the spinal cord.

Most people with minimal CMI suffer years, if not a lifetime, without a diagnosis. CMI cases were rarely diagnosed before the early 80's when use of MRI technology became more prevalent in the medical field. Unfortunately, despite advances made due to the use of MRI, minimal cases of CMI are almost always overlooked. It is not uncommon for an MRI to clearly show a lack of CSF flow space posterior to the cerebellum and, yet, be reported as normal. Various neurological deficits can indicate a medical problem exists. But, these indicators may introduce an entirely new problem - the possibility of misdiagnosis.

CMI is commonly mistaken for Multiple Sclerosis because its symptoms are so similar. As with MS, symptoms of CMI usually appear in women between the ages of 20 - 40. Both conditions include neck pain, pressure in the neck, frequent headaches, dizziness, blurred vision, difficulty with motor skills, numbness, balance problems and muscle weakness. Patients are often diagnosed with MS, based on symptoms alone, even though testing of bodily fluids have provided no definitive diagnosis. Therefore, minimal CMI should be considered a possibility in MS patients when a diagnosis has been made based solely on symptoms.

It is not uncommon for CMI headaches to be mistaken for rebound headaches because of their chronic, recurring nature and the fact that they are usually relieved by caffeine. The blockage(s) caused by CMI introduces complex problems to the balance of blood and cerebral spinal fluid inside the cranial cavity. A buildup of fluids inside the cranium due to blockage, or lack of flow, causes an increase in pressure. Caffeine has very strong vaso-constrictive effects, reducing blood volume inside the skull, and thereby relieving pressure and headache.

Perhaps the most common misdiagnosis is that of Chronic Fatigue Syndrome. The nature of CMI is to present symptoms for which no cause can be found. For most doctors, CMI is a very puzzling condition. Headache, sore throat, and fatigue are just a few of the symptoms found in both conditions. Most CMI sufferers report having been previously diagnosed with CFS or some other variation of this disease (CFIDS, Fibromyalgia).

Spinal taps can also be very useful in diagnosing CMI by revealing elevated intracranial pressure (ICP). This provides real medical evidence that there is a legitimate medical concern. However, there is still the potential for misdiagnosis. Elevated ICP can be indicative of CMI or, another well-known condition called PTC (pseudotumor cerebri). PTC is described as an increase in intracranial pressure for which there is no known cause. Although little is understood of the exact cause(s) of PTC, it is much more likely to be diagnosed than minimal CMI when raised ICP is the primary symptom. Ironically, it is proven that a blockage of cerebral spinal fluid, such as CMI, can cause the increase of ICP often thought to be indicative of PTC³.

The concern of mistaking CMI for PTC lies in the choice of treatment. Lumbar shunts are the treatment of choice for PTC but, can lead to acquired CMI in patients (meaning herniation of the cerebellar tonsils).⁵ A lumbar shunt (or valve) is permanently installed in the lumbar region of the spine, and is used to drain cerebral spinal fluid when ICP levels become higher than normal. While lumbar shunts are good solutions for persons suffering from PTC alone, they may present the same risks as spinal taps in persons with CMI - but, occurring over a longer, more extended period of time (read more on SPINAL TAPS. There are documented cases in which patients have been diagnosed with PTC, had a lumbar shunt placed, and years later been found to have CMI with herniation that was not present at the time of the original PTC diagnosis. The circumstantial evidence seems to indicate there may be an unknown number of patients diagnosed with PTC who actually have minimal CMI. Whether those numbers are signifcant or not, remains to be seen. A person having CMI and receiving a lumbar shunt as treatment would likely have years of relief before worsening CMI symptoms would occur, and a proper diagnosis made. There are alternative treatments for PTC (other than lumbar shunts) that would pose less risk should the patient actually have minimal CMI. This is something that should be considered. Again, the evidence is circumstantial but, does seem to indicate the possibility of misdiagnosis in some patients.

Minimal cases of CMI (those with herniations less than 5mm) are more at risk for misdiagnosis than those with significant herniations. It should also be pointed out that MS and PTC are both equally serious conditions that should not be dismissed easily. The bottom line is, these conditions are extremely difficult to differentiate, and much care should be taken in their diagnosis and treatment.