Diagnosis

Traditionally, when symptoms as discussed in the previous chapter have lead your physician to suspect a Chiari Malformation, plain x-rays of the head and spine were performed followed by a myelogram (a contrast agent is injected via a spinal tap into the spinal fluid and then a series of x-rays are taken which image the spinal fluid space and its contents including the spinal cord and nerve roots). Due to its invasive nature, there was always a reluctance to perform this test until the severity of the symptoms warranted it. The introduction of modern imaging techniques, specifically the MR scanner, has radically changed the evaluation of symptoms referable to the spinal cord. This test is non-invasive and as a consequence is performed much earlier in the evolution of the condition, frequently before permanent injury has occurred within the nervous system. MR imaging is now the procedure of choice for imaging the spinal cord and the fluid surrounding it. There are several different types of studies and these are used to delineate normal from abnormal anatomy. The resolution of these studies approaches that of the actual anatomy so the treating physician can gain a good understanding of the anatomical substrate which is giving rise to the symptoms. If there is concern about the surrounding bony spine, the CT scan is usually used since it can better show the bony anatomy.

Cheryl Fried, RN