Vertebral artery insufficiency, cervical instability, etc.

[Guest guest]

Hi everyone,

First of all I would like to thank everyone for your recent responses to my

question regarding chiari vs MS vs. vascular problems.

I wanted to pass along some info that might be helpful to some.

I am a physical therapist that specializes in treating balance and

vestibular problems. I have done alot of work with neurological disorders

and spine problems as well in the past (physically unable to do that type of

therapy now).

When I get a patient with balance problems or dizziness, I always check

their neck for signs of instability and/or vertebral artery insufficiency.

There are several screening tests that I perform. If I suspect either or

both of these problems, I send them back to their MD recommending further

testing to rule out these problems as well as a neurosurgical consultation.

The symptoms of both cervical instability and/or vertebral artery

insufficiency are very similar to chiari.

I have been talking with doctors on how to best assess these problems

diagnostically. Some recommended tests have been Doppler ultrasound of the

vertebral arteries (if possible in different head positions--especially

rotation and extension), flexion/extension xrays of the cervical spine,

MRA(if possible with different head positions--whatever is aggravatiing to

the symptoms, usually rotation and/or extension),functional MRIs (if

available in your area--very new). Of course, there are cerebral angiograms

as well but the risks are much greater than in the previous tests I

mentioned.

So if your symptoms are worsened with certain neck motions or positions as

many of ours are and/or if your symptoms started after a head or neck injury

or car accident, ruling out these problems would be a good idea.

Chiari can compress the vertebral arteries as they enter the skull through

the crowded foramen magnum. However, there are other possible causes as well

that would not be alleviated through decompression. So have it checked out

before decompression if possible or afterwards if you continue to have

symptoms, e.g. dizziness, facial numbness, tingling around your lips, or

other symptoms, especially if they are worsened with neck motions.

I do have a positive vertebral artery insufficiency test--extension with

left rotation leads to increased left facial numbness and numbness inside my

mouth and leads to increased difficulty focusing and lightheadedness. So I

will be having some tests to rule out cervical instability and/or vertebral

artery insufficiency. I will let you know what they discover and which

tests are most helpful.

I hope this information is helpful to others.

Take Care,

Jane

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