Another Reference By A Dr. Of Chiari/brain/neck Contributor Of Pots

[sue1234]

I found this reading around. This statement is from a doctor that treats Chiari. I am listing all these things I find that are "different" than what the mainstream POTS doctors are looking at, because I keep coming back to the SAME thing-----a problem with the head and neck! Once again, I mention that alot of us here have joint issues from various pathologies, but might still have similar effects with the neck, spine, cranial position, etc. Once again, I don't mention these to say, "Hey, I found what we all have!". I list it so if even one of us could find our cause, and it can be fixed, that would be the most wonderful conclusion to a life-altering problem. (halfway down is the important reference to POTS)

"What are some cardiac manifestations of CMI?

Heart and brain are linked at many levels. Many of the neural circuits involved in modulating the functions of the heart are anatomically located in the same "neighborhood" of CMI. Plus, a dysfunctional heart can affect the brain, by falling short in providing an adequate supply of blood (with right pressure, oxygenation, and amount of nutrients).

On the grounds of our experience at TCI, not any tonsillar hernation can give cardiac problems. Large tonsillar herniations which exert a significant mass effect on the inferior part of the brainstem (medulla), generally are the culprits in triggering arrhythmias. Supra-Ventricular Tachicardias (or SVT"s) are the most common arrhythmias in CMI patients. Arrhythmias are "felt" by the CMI patients as palpitations.

If CMI is compounded by retroflexion of the odontoid, basilar impression, basilar invagination, with or withour cranial settling, then the patients are at risk of Postural Orthostatic Tachicardia Syndrome (POTS). In these patients, whenever the position changes from supine to sitting, or from supine to standing, the heart rate accelerates drastically; in its frantic frenzy, the heart fails to move an adequate amount of blood, and the blood pressure drops; inadequate blood pressure to the brain causes debilitating dizziness, and the patient has to lie down supine again.

In extreme cases, cardiac pacemakers have to be inserted. Only 9 patients of the large TCI database have a pacemaker in place.

We did not observe any higher incidence of Myocardial Infarction (MI) in CMI patients.

Paolo Bolognese, MD "

[targs66]

Thanks, Sue. I agree with you - leave no stone unturned in this search for answers!!

[kitt]

Chairi malformation is referenced several times in the new Mayo pots paper several times. (Online here on a separate thread.)

Some dancing around it, but certainly not avoiding it. Very interesting as this has shown up for years as an aspect of chronic fatigue syndrome in published papers. Not conclusive, but mentioned much the same way it's mentioned here.

This new Mayo papers makes a direct link between Pots and CFS (which is an amazing leap, and far overdue on their part) but finally.

Here's one comment in the Mayo paper about Chiari malformaion.

Quoting "Orthostatic intolerance has also been reported in patients with type 1 Chiari malformation. In some cases associated with syringomyelia. However, a direct between incidental type 1 Chiari malformation and orthostatic intolerance has not been convincingly demonstrated"

Note the use of the words 'incidental'. As I have stated before, in my opinion Mayo researches tend to regard important findings as incidental.

There are other references to Chiari in the Mayo paper, but none as significant as the one I mentioned...(at least not one I've found. It's a tedious paper though.)

Chiari has come up in multiple papers on CFS, and now even Mayo is making very defined statements about the relationship between CFS and pots. As I said a huge leap on their part. How long before they acknowledge Chiari malformation as something other than an 'incidental finding'?

Think Chiari is becoming (continues to become) an interesting and ongoing aspect of pots research. If it was not an aspect they're considering, why would they continually include mentions of it in research papers?

[anna]

The following link is to do with neck instability in paediatric medicine but you may find some of the article of interest as this is all well established medical information: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2656787/