News that Tiger Woods’ former mistress Rachel Uchitel will undergo brain surgery later this month to correct Chiari has many turning to the Internet to find out exactly what the condition is.
Dr. Sorel Vorster, a neurological surgeon at the Cleveland Clinic who is not treating Uchitel, told FoxNews.com that the condition occurs when in there is permeation of the cerebellum into the spinal canal. The condition is thought to be congenital and while it’s not considered rare, it is considered uncommon.
Some patients will become symptomatic in infancy or childhood, while many will experience symptoms in young adulthood.
“Most common symptoms are headaches in the back of the head or upper part of the neck, and more serious symptoms are things like numbness or tingling around the face or tongue, weakness in arms or legs, difficulty swallowing, poor balance, difficulty walking and cognitive complaints like episodes of forgetfulness or episodes of unusual behavior,” Vorster said.
Typically, patients experience a wide variation of symptoms and are given an MRI of either the brain or neck depending on where the symptoms present. In many cases, doctors may believe that the symptoms are being caused by a pinched nerve, and the Chiari is discovered incidentally.
“The first step is to make sure the permeation of the cerebellum tissue is connected to the symptoms that the patient is experiencing because sometimes people have this exact same permeation with no symptoms at all,” Vorster said.
In addition to the initial MRI scan, patients are also given a cervical scan to determine whether there is any spinal fluid on the spinal cord. Many patients will first be given medications to treat symptoms to see if they respond. Vorster said if symptoms are purely of the headache nature, a neurologist is consulted to see if symptoms can be controlled in any way other than surgery.
“The most important decision is to make sure we want to go ahead with treatment, because the only definitive treatment is surgical,” Vorster said. “In treatment, we have a high threshold before we decide on surgery.”
“We want to avoid surgery if we can,” Vorster said.
Once the discovery of the Chiari is determined to not be incidental and the diagnosis is confirmed, surgeons will perform a surgical decompression on the patient, which involves surgery on the back of the neck and bottom of the skull. It typically takes 1-2 hours and requires the removal of part of the bottom of the skull to enlarge the area where the compression occurs. Neurosurgeons also open the coverings of the brain and enlarge the area with a patch to reestablish flow for the spinal fluid around the afflicted part of the spinal cord and lower part of the brain.
Patients undergo a gradual recovery which can take anywhere from a week to two months, depending on how severe the patient’s symptoms are. During this period of recovery, patients are advised against physical activity or lifting heavy objects and doctors monitor for spinal fluid leakage around the patch. If leakage is significant, surgeons would have to perform the procedure again.
“The main concern about this condition is we want to warn patients that they shouldn’t go for surgery just because they have a report from the radiologist that states Chiari because it doesn’t always require treatment,” Vorster said. “Very often Chiari is an incidental finding and if they don’t need immediate surgery we caution against it.”
Vorster said with any Chiari diagnosis it’s important to get a second opinion to determine whether or not a patient’s symptoms are related to the condition.