The Complexity of Arnold-Chiari Malformation

Submitted by SerendipUpdate on Mon, 01/14/2008 - 9:47am

Biology 202

Nicki Lynn Pollock

To the medical doctor, Arnold-Chiari Malformation, which may have a genetic link, is
characterized by a small or misshapen posterior fossa (the depression in the back of
the skull), a reduction in cerebrospinal fluid pathways and a protrusion of the
cerebellar tonsils through the bottom of the skull (foramen magnum) into the spinal
canal resulting in a multitude of sensory-motor problems and even some
autonomous malfunctions (1). These many symptoms can come in a variety of
forms which often makes a clinical diagnosis difficult. To the patient this disorder
can present not only physical difficulties but also mental distress. Treatment options
and their success rates vary widely, and proponents of the cause are demanding
more recognition, research, and success. The study of Arnold-Chiari malformations
can lead to additional questions and new understandings about the I-function,
sensory-motor input/output paths and the general make-up of the brain and nervous
system, but a complete understanding of the disorder may be a long time coming.

Impairment and sometimes loss of motor control of the body and its extremities is
one of the many effects of this disorder. Patients may complain of headaches, neck
pain, coughing, sneezing, dizziness, vertigo, disequilibrium, muscle weakness,
balance problems, and loss of fine motor control (1). The senses (hearing, sight,
smell etc.) may also be affected in deleterious ways. On can have blurred vision,
decreased sensation of limbs, unable to locate them without looking, decreased
sense of taste, ringing of the ears etc. (2).

Two ideas about the nervous system that can be better understood from these
observations are the concepts of having and locating the I-function. It seems that
the I-function here is very often affected in terms of voluntary movement. A person
with Arnold-Chiari malformation who has lost the feeling in and control of his arm for
example will not be able to move it even upon someone's request and his or her
own desire to do so. Some use of the I-function is definitely impaired. However,
these observations do not seem to necessarily imply that some part of the I-function
was damaged, because it may very well be located elsewhere- connections may
have simply been lost. A person with Arnold-Chiari can still think and have a sense
of self, but somehow can not connect with the various body parts that can be

affected. Some uses and pathways of the I-function can be understood, but the
exact location of it remains vague.

A lack of sensory input can also provide clues about pathways within the nervous
system. Depending on the severity and specific location of the Chiari malformation
different senses may be affected. Again, the location of where this information is
processed can not be determined for sure from these observations alone. It is
obvious that the pathway needed for sensory information to travel is indeed
affected but not the ultimate processing center itself.

Recently, diagnosing this disorder has become relatively easier with the advent of
the MRI (magnetic resonance imaging) so that doctors and patients no longer have
to rely on a symptom-based diagnosis which was troublesome for both (3). The
symptoms vary widely and encompass many parts of the body. Many deemed
Arnold-Chiari sufferers the victims of some psychosomatic disease before the
biological nature of the disorder was understood (5). Now, with the possibility of
having a genetic predisposition for Chiari and the early detection devices available,
one can more easily be diagnosed properly (2).

There are both medical and non-medical ways to treat Arnold-Chiari malformations.
When symptoms develop, patients should seek a doctor's advice to consider a
posterior fossa and upper cervical decompression. This procedure can provide more
room around the lower brainstem and promotes improved neurologic functioning,
though it is not a guaranteed solution (3). Patients may also benefit from various
and symptom appropriate forms of physical and occupational therapy. Some
patients also explore non-traditional options such as herbal therapy, acupuncture
and others (5).

The symptomology of Arnold-Chiari malformations can lead to many useful

observations of the pathways used by the nervous system to maintain control and
awareness of the body in terms of the I-function and sensory-motor abilities.
However, due to this large range of symptoms and the fact that current attempts to
treat them all are not always successful, there may be other things going on in
other areas of the nervous system which contribute to the overall effect of Chiari.
The situation at the base of the skull, where the malformations are readily
noticeable and are thought to be the cause, may be more complicated then
believed or known at the time. As always, a better understanding of what is actually
happening in patients with Arnold-Chiari malformation is needed.