ACMSM (Arnold Chiari Malformation With Syringo Hydro Myelia): Non-Invasive Management-A Case Study
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ACMSM (Arnold Chiari Malformation with Syringo Hydro Myelia): Non-invasive Management-A Case Study

 
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Manager NTPC

Case History of 5 yr, Male

Head injury on 08 Nov. 2006 (CT+EEG brain after head injury)

Present symptoms: He is absolutely normal till now and very active in all respects externally

Diagnosis: Arnold Chiari Malformation-1 with Syringohydromyelia(ACM/SM) and have been advised for FMD (Foramen Magnum Decompression). He is asymptomatic till now and got checked on 08/11/2006 which further diagnosed the ACM/SM..

Till now we have only plain MRI & contrast MRI of brain & spine which has revealed 7 mm mild herniation of cerebellar tonsile below the level of foramen magnum s/o ACM-1 and focal area of syringohydromyelia in cervical cord extending from C3-4 to C7 vertebra level.

His Diagnostic reports copy and MRI prints etc details are available on request to bk4price[at]yahoo.co.uk

Patient got a back fall from house swing on 8th Nov 2006, and lost his control on body, at 7:15 PM. He became conscious and responding after 30 minute.

The back side head injury was not bleeding, he had pain there, so to rule out brain hemorrhage Local Surgen referred to Neurologist with Brain MRI Diagnostic tool. At 11:00 PM CT Scan report was normal as detailed next:

09-11-2006:Neurologist wanted to probe into his abnormal non responding act after fall from the swing, though everything was normal externally, so he looked for Brain EEG test, the report is next

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EEG Brain:09th Nov 2006

EEG of Brain: background consists of 8 cps alpha activity bilaterally, a few bursts of 3 cps slow activity is seen. Impression: Bursts of slow activities could be epileptogenic.

Neurologist advised for MRI Brain, where the case of Chiari Diagonosed, then MRI of CD & DL spine were advised

MRI of the Brain:09th Nov’06

Protocol: Axial: T2 TSE, T1 SE; Sagittal: T1SE; Coronal: FLAIR

Findings:

> Both cerebral hemispheres show normal grey-white matter differentiation.
> No evidence of any focal parenchymal lesion.
>Basal ganglia and thalami are normal.
>Mild herniation of cerebellar tonsil is seen. The cerebellar tonsil measures 0.7 cm below the foramen magnum.
>Posterior fossa structures including fourth ventricle are normal.
>Basal cisterns & supratentorial ventricular systems are normal.
>No evidence of any extra axial collection.

Impression: Mild herniation of cerebellar tonsil below the level of foramen magnum. S/0 Arnold Chiari Malformation

Adv: Evaluation of the whole of the spine cord to rule out other associated abnormalities

MRI of Cervico-Dorsal Spine:

Protocol: Sagittal: T1 SE, T2 TSE; Axial: FL 2D

Findings:

>Vertebral bodies are normal in height & signal intensity.
>Intervertebral discs are normal in height and signal intensity.
>Neural foramina & nerve roots are normal.
>Cervical cord shows a cystic lesion extending from C4 to C7 vertebra level. It measures 3.2 x 1.1 x 0.9 cm. The lesion shows two locules & located in the central part of the cord, s/o syringohydromyelia.
>Spinal canal & rest of thespinal cord appears normal.
>Posterior elements & facet joints are normal.
> Pre & paravertebral soft tissues are within normal limits.


Impression: Focal Area of SyringoHydroMyelia in Cervical cord extending from C4 to C7 Vertebra.

MRI of D-L Spine:

Protocol: Sagittal: T1 SE, T2 TSE; Axial: T1 SE, T2 TSE

Findings:

>normal curvature & alignment of dorsao-lumbar spine.
>Vertebral bodies are normal in height & signal intensity.
>Intervertebral discs are normal in height and signal intensity.
>Neural foramina & nerve roots are normal.
>Spinal canal & cauda equina fibers are normal.
>Posterior elements & facet joints are normal.
> Pre & Para vertebral soft tissues are within normal limits.

Impression: Normal MRI study of D-L spine.
Muscle Charting: every activity 4+, every muscle good.

Management:

Referred to neurosurgeon: Neurologist referred to Neuro Surgeon, who considered it for immediate sugical intervention, advised for LP/VP shunt, intution not agreed to it.“Intramodullary syrinx, at C3 4 5 6 level which needs surgical technique.” he said ” We should plan in a week or two”

Also advised for FMD (Foramen Magnum Decompression) instead of LP/VP shunt, for better Management of ACMSM

NSg confirmed that Surgical intervention is must, all pros and cons explained , another opinion from panel of NSgs-can wait a quarter or till anyone symptoms develop, may be within six months. Other NSg hoped for revival and review after 6 months as it was asymptomatic.

TCI (The Chiari Institute) Great Neck New York, USA and WACMA (World Arnold Chiari Management Association) educated us that the case is very critical and an aggressive brain surgery by the surgeon of expert in Chiari experiencing 2-3 Chiarian surgeries per day can safely handle this case. It may cost Rs. 2.0 crore to meet out this requirement, if TCI performs this.

Teleconsultation confirmed all: Teleconsultation with all possible Neuro Surgeons, Neurologist confirmed that the case cannot be managed without surgery at any cost.

Other NSg reported some left leg lower limb weakness, as it was found that patient is unable to manage the balance many a times while runs, also falls/slips unnaturally.(16/04/2007)

Readiness for Surgery: While Surgery was almost agreed to and decided within next 3 months before Jul’07, meanwhile through Rajyoga Meditation, We used telepathy, intuition, divine intellect and blessings of Brahmin (BK) Family and other well wishers in NTPC/Lokik family to receive Godly blessing in finding a hope where an email showing positive brain reformation at an Ashram Dharamshala and use of Psychic Yogi Power by Mr Yuri Geller (CD available at GS, academy for better world)

Mysterious Diagonosis:

Discovery Heath Channel showed a documentary named “Mystery Diagnosis” where case of ‘s ACMSM and her Posterior fossa decompression surgery was shown.

We all shocked with the open surgical intervention and the practical risks associated shown in the film, but got educated a lot, seriously thinking to find an alternate immediately, otherwise Patient is going to live on bed & wheel chair for the life.

Divine Family’s Help: With the help of BKs, encouraged to go thru alternate medicines and therapies WITH Faith on Almighty. Homoeopathy treatment advised different course of Medicines for 2 years.

6 month treatment:

May’07 to Nov’07, continued with Homoeopathy and naturopathy (Therapeutic Diet, excersises,postural guidance etc), Rajyoga meditation, Accupressure, Magnetic therapy, Prayers/Divine well wishes from all known people around us, Patient was assured to have a will power that Patient will not face Surgery and get relieved through Meditation and proper diet. Patient co-operated very well and remained enthusiastic and fully zeal

Nov’07 had acupuncture sitting for 12 days till 12th Nov. 16th Nov ’2007 repeat MRI done.

Results encouraged, Chiari regressed 16/11/2007: MRI of CERVICAL SPINE:

MRI of cervical spine performed using T1W & T2W sequence in multiple planes.

Clinical profiles:

Head injury on 08/11/2007. No symptoms at present.

Imaging Features:

The study reveals a well defined focal area of abnormal singal intensity appearing diffusely hypointense on T1W sequence and hyperintense on T2W sequences in the intramedullary region of the cervical spine cord. The approx. 21mm (SI) x 6.5 mm(AP) x 9.0 mm (Lat). It extends from the mid part of vertebral body level to the mid part of C7 vertebral body level. There is mild expansion of the cervical spine cord.

No other focal intramedullary or intradural lesion is seen in the visualized spinal cord.

There is mild elongation of the cerebellar tonsil, however there is no herniation of the tonsil through the foramen magnum into the cervical region.

Alignment and curvature of cervical vertebrae is maintained.

The cervical vertebrae reveal normal marrow signal intensity.

The intervertebral disc spaces are normal.

The facet joints are normal.

Impression:MR Imaging reveals a well defined focal area of abnormal signal intensity in the intramedullary region of the cervical spinal cord, extending from the mid part of C4 vertebral body level to the mid part of C7 vertebral body level with mild expansion of the cervical spinal cord. These findings are likely to represent syringohydromyelia.

No evidence of tonsillar herniation.

Syrinx regression treatment contd: Encouraged with these results, AIIMS NSg reviewed and advised:”No N/S intervention required, review after 1 year or SOS”

Patient is under same treatment as before.

Inference:

Any congenital disease can be managed till it becomes symptomatic, with the help of non-invasive techniques as discussed in Patient’s case study.

The moment, any symptoms are developed, then invasive techniques may or may not be applied depending on case to case symptoms and the severity of the disease.

ACMSM patients can hope good results after going through this case study, some of the interesting points to be noted in this case are:

GOD is our Father, as well as the Supreme Surgeon. When Patient born, the Horoscope had indication of some mysterious malformation in brain, which would remain silent and could not be easily traced out. Tthis point noted in mind and it kept a close eye on Patient ’s mental activities to find out any clue of the mystery. On 8th Nov’2006, the activities of Patient made us rush to investigate, in spite of the fact that local Gen Surgeon and Orthopaedic Surgeon told that Patient is normal, there is no need to go for CT/MRI as the Child became normal in the hospital and he may have a mental shock due to fall...but we not agreed, we had intuition for something mysterious inside.

CT report was normal, by 11:00 pm on 8th but we could not sleep well, though Neurologist also found Patient absolutely normal in next morning, he also could not relate the last evening happening with ACMSM....so further probing was done by EEG analysis....it showed some abnormality but the inference of epileplogenic or cerebral palsy not acceptable to the family compelled further diagnosis through MRI brain, wherein also there was no indication for anything related to the past evening’s event, but it became an opportunity to find out ACMSM because of the experience of the Radiologist & the technician, as well as because the GOD wanted to help us. In ACMSM cases, patients had lost years to come to diagnose Chiari whereas here Patient's chiari diagnosed in an opportunity.

Next day on 10th Nov, Neuro Surgeon’s advise for brain Surgery, immediate, in view of the Syrinx, also could not be acceptable to the family, as we were in view of consultation with other NSg for second opinion, and had a view that the Horoscope not shows any possibility of the requirement of Surgery to manage the Mystery which is now ACMSM. But none of the NSgs assured that this case can be managed without Surgical intervention, since syrinx is present.

Internet surfing, telecalling, teleconferencing and all other tools learnt the us a lot about ACMSM as we had no background of life science,being Engineer, but we could understand well after the study, as ACMSM is a mechanical malformation. GOD father Shiva’s lovefull communication in Rajyoga Meditation & telepathic communication guided from the Supreme Soul through His Corporeal medium of the Soul of Prajapita Brahma Baba in the Angel form, to find out the different ways to manage his Chiari, through internet & the CDs available at Gyan Sarovar- Academy for Better World, Mount Abu.

All possible ways on non-invasive management techniques were applied on Patient, having no precedence of any success achieved by any ACMSM patient with non-invasive management, but with the help of GOD Father Shiv Baba and the Divine family’s well wishes, ultimately Chiari got regressed and the Syrinx also reduced.

Next MRI is due in July’2009. Hope that Patient’s SM will be reduced further...

In Sweet Rememberance of our Dearest God Father Shiva, The World Almighty Authority, The Supreme Soul & the Angel Brahma Baba

Omshanti

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