Is restricted CSF on a cine mri the same as CSF blockage? Is there anyone out there with restricted CSF that is waiting to have surgery? I have 5-8mm herniation, no symptoms other than dizziness and no syrinx.
The definition of Blockage:
When I saw my neurosurgeon in the fall of 2012, I had "partial blockage" and he advised me to try several avenues to deal with my symptoms first. When I had my next MRI seven months later I had complete blockage. At that point my neurosurgeon said, "I think I can help you, if you want to have the surgery." None of the other avenues had offered any relief that wasn't very temporary. So, my husband and I scheduled my appointment for surgery for two weeks from that visit. For me, because things had changed so quickly, I did not want to wait any longer. In between those two visits and two CINE MRI's I kept track of my symptoms on a regular basis. I used an app called Symple. I liked it because I could include the symptoms I wanted to (you know because Chiari is so different for each person). I took a summery of that info with me to the second appointment. My symptoms had increased in severity and frequency and new ones had developed. I was "out of commission" anywhere from 1-4 days out of the week. I did not want to be "sick Mommy" any more. I was tired of missing out on everything. Anyway, between the way I was feeling and what the second cine MRI confirmed, I was not willing to wait any more to see what might happen next. I'm ten weeks out from surgery now...I wrote my success story on the discussion board about successes. Let me know if I can be of any help to you as you walk this road.
Hi there I had the same. My NS inserted a pressure monitor for a few days to see how many pressure is building up. The result was that they had to put in a schunt. (My herniation 8 mm) this was done 2 weeks ago. My headaches are better but the dissiness is still there. My dr said I need to accept certain symptoms will always be there with chiari.
That's depressing Riana. I'd consider a different perspective from a different doctor. Maybe check out the list of Chiari doctors available on this site. They may be able to make your prospects for your life less depressing. I'd hate the thought of condemning my daughter to a lifetime of pain & discomfort. It took me a lot research of doctors before we found one that was willing to help us find solutions. Much better than settling for a lifetime of just living with it.
Hi ladies, I live in England and I’m waiting to see a new NS, I have had 3 surgeries all ready and my cine MRI shows no flow at all posteriorly. Having awful headaches and numbness in hands and feet, what do u think he might suggest? I’ve already had the decompression surgery, haven’t got a shunt but I’ve got a cyst xx
In terms of blockage versus restriction, it's really a matter of degrees. It may also be preferred phrasing of the reading radiologist. Blockage should be no flow is seen. Restricted should be some flow is seen, but not normal. Frustratingly, the end result may be the same. It gets back to the question of symptoms. Restricted CSF flow may lead to severe symptoms and blocked flow may lead to no symptoms. Usually, blocked is worse(but the quality of the MRI matters, e.g. you see flow better on a 3T vs a 1.5T MRI). Some issue with degree of cerebellar tonsillar ectopia. 23mm is usually worse than 13mm, but not in all cases.
The degree of flow blockage is a factor the treating MD(usually surgeon) will take into account to decide surgery or not, just as degree of cerebellar tonsilar ectopia is. Clearly, the most important factor is the patient and their symptoms.
Thanks for your reply Dr Trumbles, what do you suggest for a re occurring pusedomeningocele near the brain stem and no flow posteriorly? Suffering horrendous chiari type headaches,bending, laughing ect and constant pain at the back of the head. I’m seeing a new NS in Birmingham at the Queen Elizabeth hospital called Mr Graham Flint.
This is the 3rd pusedomeningocele I have had,already had decompression surgery, yet the cine MRI shows no flow posterior and very little flow anterior,does this make sense? I’m I right to believe that the decompression hasn’t been a success? I’m not seeing Mr Flint till 3rd September, this is how our health system works in England! Have no idea what he may suggest and I’m very apprendsive, had 3 surgeries fail so far. Currently taking topiramate and diamox but still suffering x
You are welcome Mandy. It appears that I have been booted from this conversation. In fact I think that is why I stopped adding input on this site originally. I have a physical answer for a physical problem which is very often effective. Please let me know if I can help you in the future.
Dr. Michlin, thank you for replying, this is an interesting article. I am interested in hearing more about AO treatments and your results with Chiari patients. I have looked into it a bit, but I have been concerned about making my herniation worse.
Thanks everyone for your input. So, with symptoms being only dizziness should I start with seeing a otoneurologist or go straight to a neurosurgeon? Won't most neurosurgeons just say have surgery because that is what have been trained to do? I really don't want to have surgery until my symptoms are interfering with my quality of life. Thanks-
If you have a pseudomeningocele and obstruction to flow, you must have ongoing pressure(something is causing the leak).
For most similar patients, I re-explore the pseudomeningocele and close the leak(a stitch has usually pulled through dura thinned by chronic Chiari pressure). If you simply place a stitch in the hole, there is no reason to think it is any better than the original closure. therefore, I routinely place a lumbar drain to allow CSF to drain out the back for a few days, preventing pressure on the new dural closure. I drain the patients for 2-3 days, clamp the drain, and monitor pressure. A small percentage of Chiari patients will have idiopathic intracranial hypertension(formerly called pseudotumor cerebri). If the CSF pressure is elevated, a shunt is usually indicated(a ventriculo-peritoneal shunt in the Chiari patient population, in order to minimize risk of worsening cerebellar tonsilar herniation).
Each surgeon has their own routine but you somehow need to adddress the leak and minimize risk of recurrence. the above routine is one of the more common pathways.
Thanks for your reply Dr Trumbles, what do you suggest for a re occurring pusedomeningocele near the brain stem and no flow posteriorly? Suffering horrendous chiari type headaches,bending, laughing ect and constant pain at the back of the head. I'm seeing a new NS in Birmingham at the Queen Elizabeth hospital called Mr Graham Flint.
Thanks again Dr Trumbles for your reply. I had a lumbar drain fitted last October after the 2nd psuedomeningocele was repaired and had it in for 3 days so I can’t understand why it has come back again?! Only why what you have said in that I have high cranial pressure. With the cyst being next to the brain stem could that be blocking the flow causing the pressures to increase even higher? Headaches are horrendous!!! Can’t laugh or cough or bend without gripping my head! Would be a safe guess that the new NS might suggest to shunt it there fore opening the blocked csf flow and decreasing the cranial pressure?
Yes, the cyst could be blocking CSF flow. And, yes, a shunt may be in your future. Some neurosurgeons will try an external ventricular drain first(basically a lumbar drain but in the head), some will simply proceed to a shunt. If you've failed 3 times, it's time to try something else.
Thanks again Dr Trumbles for your reply. I had a lumbar drain fitted last October after the 2nd psuedomeningocele was repaired and had it in for 3 days so I can't understand why it has come back again?! Only why what you have said in that I have high cranial pressure. With the cyst being next to the brain stem could that be blocking the flow causing the pressures to increase even higher? Headaches are horrendous!!! Can't laugh or cough or bend without gripping my head! Would be a safe guess that the new NS might suggest to shunt it there fore opening the blocked csf flow and decreasing the cranial pressure?
Much appreciated Dr Trumbles, thank you for all help and advice x
How are you getting on, I know I am late to the post. I am from England and trying for a diagnosis but its proving tricky. I don’t know if you are still active on this site so won’t write to much but will be good to hear more of your story.
I have restricted CSF. I had the dizziness n nausea. Then neck n headaches eventually started. I also would get a feeling in my brain like it flipped or did a complete 360° turn in my head in an instant. It will do it sometimes like 5 times in a 10 minute time frame. They put a shunt in about a month ago. It’s turned up as high as it can go n headaches came back so now I am having surgery Dec. 4 th. The headaches stopped for about a week n now have come back. All of this is so crazy to me. I never know what to expect. I have a 7 mm herniation. So hopefully then with surgery n shunt adjustments it may get better.
My dtrs MRI yesterday revealed restriction to her CPF. I’m awaiting my appnt Monday with the Neuosurgeon. I’m nervous. 1. Because it seems like these fixes are super invasive and 2. They don’t work long term. I’m wondering why would the pain subside and then just come back? I hope you get relief soon and you have good people helping you.