Chiari Malformation Injuries Caused by Car Accidents
A Chiari malformation (CM)—also commonly referred to as cerebellar ectopia or Arnold Chiari malformation—is a structural defect in the lower-rear portion of the brain (cerebellum). This is the part of the brain that controls balance. CM is most commonly caused by a congenital defect and is often present at birth. In fact, doctors were sure that developments before and directly after birth were the only possible causes of the malformation. However, acquired Chiari malformation can develop later in life due to trauma, disease, or infection.
However, several recent studies have shown a correlation between a traumatic incident (i.e., auto accident or slip-and-fall) and symptomatic CM. In other words, a Chiari malformation can be asymptomatic for an indefinite period of time until a traumatic episode instigates its symptoms. For lots of injury victims, this comes as a surprise since most individuals with an underlying Chiari malformation have no idea they even have it. Now, research is coming out that may suggest that trauma can not only awaken CM symptoms but actually cause acquired Chiari malformation altogether.
A Chiari malformation is a structural defect, in this case, an enlargement, of the cerebellum. Normally, the cerebellum and the upper portion of the brain stem sit in an indented space at the lower rear base of the skull. When part of the cerebellum is too large to sit in this area and so begins to extrude below the large opening at the back of the skull (foramen magnum), it is called a Chiari malformation. This protrusion can cause skull bulges as the cerebellar tissue pushes through the foramen magnum.
Since the bony space is smaller than normal, it causes the lower part of the cerebellum, called the cerebellar tonsils and brain stem, to be pushed down into an area called the foramen magnum and into the upper spinal canal. The resulting pressure on the cerebellum and brain stem may affect functions controlled by these areas and block the flow of cerebrospinal fluid. Cerebrospinal fluid (CSF) is the clear liquid that surrounds and cushions the brain and spinal cord. This can have serious repercussions in the way the brain operates and the symptoms a patient experiences.
Chiari malformations are classified based on the extent and location of brain tissue protrusion, with Type I malformation (I malformation) being the most common. Diagnosis and treatment are Chiari malformation-based, depending on the severity and symptoms.
A Chiari malformation is a structural defect, in this case, an enlargement, of the cerebellum.
Chiari Malformation Symptoms
The symptoms most often associated with a Chiari malformation are headaches, neck pain, upper extremity numbness, paresthesias (the feeling of pins and needles), vision problems, and balance problems. Because the cerebellum controls balance in the brain, unsteadiness and problems with balance are also extremely common. This may extend to similar symptoms like problems with motor skills, coordination, muscle weakness, and dizziness.
Those suffering from CM may experience other common symptoms associated with problems with the brain, such as difficulty swallowing, speech issues, vision problems, and abnormal breathing. Of course, these symptoms can vary in degree and from person to person, ranging from mild to severe symptoms, especially in advanced cases. As mentioned earlier in this article, some patients never experience any symptoms at all. Some don’t notice any problems until adulthood, while others don’t have issues until a trigger is applied, leading to new symptoms. But what about the questions of trauma actually causing the Chiari malformation itself?
Can a Chiari Malformation Diagnosis be Caused by Trauma
In recent years, increased research about the causes of Chiari malformations has produced some interesting results. Initially, Chiari malformation was thought to be an exclusively congenital issue that was caused by structural defects in the brain and spinal cord during fetal development. However, recent research has revealed that Chiari malformations can also be related to trauma, especially whiplash injuries and auto accidents.
Several studies have suggested that a previously undetected Chiari malformation can be symptomatically awakened as a result of trauma caused during a motor vehicle crash. While these studies determined that head or neck trauma—including physical trauma, traumatic injury, traumatic brain injury, mild TBI, minor head injuries, and whiplash injuries—is capable of “triggering” symptoms relating to CM, in a 2010 study, Michael D. Freeman and a number of other experts set out to determine the answer to an even more intriguing question: Could car crash trauma actually be the initiating cause of a Chiari malformation?
The answer is that it’s definitely possible.
Established research has already concluded that Chiari malformation can be acquired later in life (i.e., non-congenital), known as acquired Chiari. In a procedure known as lumbar shunting, cerebrospinal fluid (CSF) levels are reduced in order to ease intracranial pressure in patients with neurological disorders. In some cases, reduced CSF levels can allow the brain to drop in the base of the skull to the point that the cerebellum’s cerebellar tonsils push through the foramen magnum, in effect causing a Chiari malformation. This occurs because the flotation level of the brain is dependent on the amount of CSF within the dural covering of the spine and brain.
There is clinical evidence showing that dural leaks causing reduced CSF levels are in fact associated with whiplash trauma. This is possible because the damage caused during the whiplash acts like a lumbar shunt, reducing the levels of CSF. The whiplash trauma then causes a dural leak that results in Chiari malformation.
Chiari Malformation Following an Auto Accident
Regardless of whether or not crash trauma triggers a pre-existing asymptomatic Chiari malformation or actually causes it, research indicates that symptoms of Chiari malformations are substantially more prevalent in whiplash-injured patients. The important takeaway from this is that if you suffer head or neck trauma in an accident, especially whiplash, you may develop symptoms and other issues that are unexpected, like a Chiari malformation. In a whiplash mechanism accident, the head moves violently forward, then backward.
This is known as an acceleration-deceleration mechanism injury. During such an episode, the cerebellar tonsils can pass through the opening at the bottom of the skull (known as the foramen magnum) and pass into the upper part of the neck. In a seminal study published in the Journal of Brain Surgery by Professor Michael Freeman and Dr. Ezriel Kornel, a correlation between acceleration-deceleration injuries and symptomatic Chiari was found after reviewing 1200 cervical MRI results. The study illustrates that a pre-existing congenital Chiari often becomes symptomatic following a motor vehicle collision. Most Chiari malformations are congenital, and symptoms may not appear until early adulthood or in a young adult, often after trauma or during tests for unrelated issues. Diagnosing a Chiari Malformation
In order to detect a Chiari malformation, healthcare providers will utilize a series of medical imaging tests as part of the diagnosis process. After reviewing medical history and reported symptoms, a doctor will either order an MRI or a CT scan. MRI stands for magnetic resonance imaging, which is a form of radiology that utilizes a machine that creates detailed images of the inside of the body with radio waves and magnets.
This is one of the most common and effective means for detecting Chiari malformations and is essential forChiarii malformation diagnosis. CT scans, or computerized tomography scans, use cross-sectional X-rays to image the body. These tests image the skull in order to determine if the cerebellar tonsils have dropped into the base of the skull to block the flow of cerebrospinal fluid and cause symptoms. The classification of Chiari malformation type is important, with Type I being the most common form, typically congenital and often asymptomatic until symptoms like headaches or neck pain develop. Chiari malformation diagnosis may also involve evaluating for associated conditions such as spinal curvature, and additional tests like a sleep study may be recommended if symptoms such as sleep apnea are present.
Chiari Malformation Treatment Options
The treatment options for a Chiari malformation depend on the severity and underlying cause, such as whether it is congenital or caused by trauma. It is important to consult a healthcare professional to determine the most appropriate treatment options. Most often, Chiari malformation is treated through surgery designed to relieve pressure on the cerebellar tonsils, which restricts the flow of cerebrospinal fluid, with the goal of halting or reversing the progression of the malformation. Successful treatment can stabilize or reduce symptoms, restore spinal fluid flow, and may also address related issues such as sleep apnea.
The most common form of surgical treatment for Chiari malformations is called posterior fossa decompression. This procedure involves the surgeon removing a section of bone at the back of your skull to relieve pressure on your brain and provide more space. In essence, a piece of bone at the base of the skull is removed to relieve pressure on the spinal cord and brain. Sometimes the dura mater, the covering on your brain, may be opened up. Over 80% of adults with a Chiari malformation claim that surgery resulted in an improvement of their condition.
Occasionally, a patch will be placed over this opening to help enlarge the area and relieve pressure on the cerebellum and brainstem, which are restricting the flow of cerebrospinal fluid. This patch may come from tissue taken from another part of the body or may be artificial. Another approach a surgeon may use is removing a small portion of the spinal column to allow more space for the spinal cord and cerebrospinal fluid.
On some occasions, when a syrinx has been identified, a surgeon may opt to create a drainage path so that spinal fluid may properly drain to prevent further complications.
Complications of a Chiari Malformation
In some cases, a Chiari malformation can become progressively worse and develop severe complications that prove very harmful and debilitating. Complications may occur due to factors relating to the root cause, such as congenital deformation, or the condition can simply get worse on its own. Additionally, exposure to harmful substances during pregnancy or medical procedures may increase the risk of acquired Chiari malformation or related complications. Some common complications of Chiari malformations include:
- Spina Bifida – When the spinal cord is not totally developed and is left dangerously exposed. The covering of the spinal.
- Hydrocephalus – The accumulation of fluids inside parts of the brain that interferes with cognitive function. In this case, it would be the cerebrospinal fluid that would require diversion to another part of the body via surgery.
- Syringomyelia – cavities or cysts that form within the spinal column. This complication is more common in type II Chiari malformations.
- Tethered Cord Syndrome – The spinal cord attaches to the spine, which causes the spinal cord to stretch and take damage. This causes severe nerve damage throughout the lower body.
Seek an Experienced Florida Car Accident Attorney
Injuries resulting from automobile accidents, particularly brain and spine injuries, can be extremely complicated. If you’re dealing with a brain or neck injury after an auto accident, it’s important to hire a personal injury firm that has extensive experience representing clients with serious or complicated injuries.
Matt Dolman and the Dolman Law team have been retained on a number of Chiari malformation cases, including several referred by other law firms. Insurance carriers often rely on outdated science depicting such injuries to be congenital and will assert that trauma played no role in the pathology. However, we focus only on the symptoms and the lack of symptoms related to Chiari pre-dating an accident. In other cases, we focus on an exacerbation or aggravation of a pre-existing condition, wherein it can be illustrated that the symptoms were dramatically altered as a result of a traumatic episode. Distinguishing between symptoms caused by a pre-existing condition and those resulting from trauma is crucial, as it can be challenging to prove causation in these cases. If the accident caused the symptoms or exacerbated them, there is still a liability.
In any event, Chiari cases are rarely resolved pre-suit. A claimant is generally left with only one potential recourse, which is filing a lawsuit. In our experience, Chiari cases are heavily laden with expert testimony. Therefore, we often retain a radiologist, neurosurgeon, and epidemiologist to illustrate the significance of this type of injury and to show that our client most likely would not have presented with such symptoms had there been no traumatic event. Symptomatic Chiari is a very serious condition that often will not resolve itself without surgical intervention. This often means a patient enduring a craniotomy. A craniotomy is an extremely invasive procedure with a number of associated risks. Due to the long-term prognosis of individuals with symptomatic Chiari, we must account for the need for potential future surgical intervention. Additionally, damages in these cases may include compensation for lost wages, medical expenses, and pain and suffering.
If you have concerns about anything related to Chiari or whiplash or want to discuss a different type of injury case, contact us at 833-552-7274 or by emailing us through our contact page.
