Arnold-Chiari Malformation

Effects of upper cervical subluxation concomitant with a mild Arnold-Chiari malformation: a case study. Smith, JL. Chiropractic Research Journal, 1997;4(2):77-81.

Note: Arnold-Chiari (A-C) malformation is a variable congenital defect of the brainstem originally described in 1894.

From the abstract:

This is the case of a 39-year-old woman with complaints of intermittent bouts of fatigue, dizziness, facial numbness, ataxia, headaches, difficulty speaking, and diffuse arthralgias (pains) during the past two years.

She had already undergone extensive medical testing which revealed a mild Arnold-Chiara Type 1 malformation. Upon further investigation, it was decided that the A-C malformation was an incidental finding, unrelated to her symptoms. Medically, no solution or explanation of her symptoms could be found.

The patient had an array of diffuse symptoms, most of which could be explained neurologically by the effects of an upper cervical subluxation.

Using the Grostic method of upper cervical analysis, the authors measured an occipito-atlanto-axial subluxation and managed the patient using the Grostic procedure of hand adjusting for the upper cervical region. Following the first and subsequent upper cervical adjustments she experienced significant relief of her symptoms. She has not felt the need to seek medical intervention since beginning chiropractic care.

Chiropractic adjustment to the cervical spine and the Arnold Chiari malformation. Murphy DR, Goldstein D, Katz M Journal of Manipulative and Physiological Therapeutics 1993;16:550-5.

Two cases of patients with Type 1 Arnold-Chiari malformation (ACM) received a series of chiropractic spinal adjustments to the cervical spine. No ill effects or complications were noted related to the ACM and ACM does not seem to be a contraindication of specific cervical adjustments.

The first case is a 37 year-old longshoreman who suffered neck pain, headache, right shoulder and scapular pain and light headedness, photophobia and blurred vision. The symptoms began after a car accident. After 12 weeks of care he was completely free from head, neck and scapula pain, lightheadedness and visual problems also resolved.

The second case is a 36 year-old internal medicine resident suffering from severe vertigo and right arm pain. It appeared that her vertigo began after she developed aseptic meningitis with labyrinthitis. Adjustments were to C2-3. After 25 adjustments the arm pain resolved completely. Her vertigo however did not resolve.

MRI of the Brain and Spine. 2nd Ed. Atas S.W. 1996. USA Lippincott-Raven

"...studies of patients with Chiari I malformations in the future are likely to focus less on the static anatomic appearance of the tonsils in relation to the foramen magnum, but rather on the dynamic motion of CSF (cerebro-spinal fluid), both in relation to physiologic motion of the brain (brain pulsation) and in relation to the mechanics of the craniocervical junction (flexion, extension, rotation)."

Dr. Joesph J. Ierano, DC of NSW Australia discusses the above:

"I would not presume that this comment was intended to pertain to the chiropractic subluxation in support of it. But it is interesting to note the reliance not on appearance of cerebellar tonsils, but on the dynamic function of the upper cervical area and CSF.

"This is why I believe that upper cervical adjustment may improve symptoms of Chiari Type I because the existence of subluxation affects the dynamic function of this area and compromises brain stem and associated nerves. Co-management remains the best option, (but try convincing your local neurosurgeon of that)."

Copyright 2004 Koren Publications, Inc. & Tedd Koren, D.C.