Automobile crashes can bring many unforeseen consequences - and the symptoms associated with Chiari malformations (most notably chronic headaches) may be some of the most important for you to know about.
Over the last two decades, an increasing body of evidence has connected this disorder to the physical trauma associated with car crash-induced whiplash. One of the authors of the most recent ground-breaking study into this connection has advised that anyone suffering from whiplash should see a healthcare provider immediately - as there is often a more serious injury with whiplash (such as Chiari) than what is initially found.
Should you or someone you know be found to be suffering from a Chiari malformation you believe is connected to a recent experience of physical trauma such as a car crash, you should be eligible for compensation. However, it is probable that the insurance industry will fight to minimize or eliminate such a payment, and thus legal representation can make a huge difference in ensuring that you are adequately compensated and financially assisted with your recovery.
A Chiari brain malformation (AKA "chronic tonsillar herniation," "cerebellar tonsillar ectopia," the "chiari anomaly," and other names) is a condition which occurs when the bottom of the cerebellum (the cerebellar tonsils) extends downwards into the spinal canal. This herniation of the cerebellum is through the large opening in the base of the skull that funnels into patient's the spinal canal.
This can cause consequences. The herniated tissue can block circulation of cerebrospinal fluid in the brain and can also lead to the formation of a cavity within the spinal cord. Many patients need surgery to address a Chiari Malformation. This type of surgery involves the surgeon "unroofing" the area of the brain and brain stem that is compressed and expands the opening by performing a duroplasty. A duraplasty is where the membrane surrounding the brain is cut open and a patch is used to expand the dural surface. It is a significant procedure.
In its mildest form, this disorder can be asymptomatic for a long period of time; in its most serious, rarer forms, it emerges in the womb or early childhood and can have very serious repercussions, including fatality.
Chiari malformation's from whiplash and automobile crashes usually involves the least severe or Type 1 Chiari malformations which are primarily at stake. Most of our law firm's motor vehicle accident cases start with Valsalva-induced headaches. There is a test may confirm this origin of the headaches.
As the least severe form of the Chiari malformation disorder, a Type 1 Chiari malformation can be asymptomatic for many years, only to be triggered by a car crash or other physical trauma and begin to manifest with symptoms. The Type 1 Chiari malformation is the only known form which is believed to not only be congenital (inherited and manifested from birth), but also to be capable of occurring solely as a result of such physical trauma. Despite being the least severe version of the Chiari malformation, the Type 1 disorder can nevertheless manifest with symptoms bringing serious pain and discomfort.
The primary and most prevalent symptom associated with a Chiari malformation are headaches and neck pain. These are often accompanied by other symptoms, which may be worse in a particular position such as when the neck is extended or flexed. Other symptoms in addition to headaches which can manifest as a consequence of this disorder include:
- Dizziness (often after a sneezing or coughing fit)
- Difficulty swallowing
- Choking and vomiting
- Difficulty balancing
- Reduced fine motor skills
- Speech problems
- Ringing or buzzing in the ears (tinnitus)
- Slow or fast heart rhythm
- Abnormal breathing (such as sleep apnea)
As this is only a partial list of symptoms, if you think you or someone you know may be suffering from a Chiari malformation you may also want to examine this lengthier list of symptoms.
Type 1 Chiari malformations can also result in a number of complications, sometimes serious, including:
Syringomyelia: This is a chronic degenerative disorder present in approximately 25% of patients with Chiari malformation, often associated with Type 1. It is characterized by a cyst filled with fluid in the spinal cord, and its symptoms include pain, numbness, weakness, and stiffness in the back, shoulders, legs, or arms. Other symptoms may include headaches, sweating, sexual dysfunction, loss of bowel and bladder control, and an inability to feel changes in temperature. The severity or presence of these symptoms varies considerably and could take months or years to fully develop. If serious enough, surgery or other treatment may be recommended.
Hydrocephalus: Like syringomyelia, this is a disorder characterized by fluid build-up - however this build-up is in the cavities of the brain, rather than the spinal cord. The excess fluid increases the size of the ventricles and puts pressure on the brain, which can result in headaches, loss of bladder control, difficulty seeing, tiredness, a loss of coordination or balance, and/or a decline in memory, concentration, or other cognitive faculties. Although this disorder can occur with any kind of Chiari malformation, it is most commonly associated with Type II.
There is currently no consensus in the medical community on whether Chiari malformations are linked to seizures. While some doctors deny that there is any connection, many patients suffering from seizures and Chiari malformations believe there is a link between the two. Furthermore, the authors of a 1997 study of Type 1 Chiari in children with seizures declared that they did not believe that the link between the two should be viewed as incidental.
Unlike Type 3 and Type 4 Chiari Malformations, the version of Chiari (Type 1) associated with automobile crashes is not considered to be life-threatening. While Type 1 Chiari can either be asymptomatic or unfortunately bring with it varyingly intense symptoms of pain and discomfort, the disorder in itself is not considered to be life-threatening.
However, it is important to note that there has been a case of sudden death attributed to Type 1 Chiari combined with physical trauma in a motorbike collision, suggesting that in such circumstances Type 1 Chiari can be a life threatening risk factor. Whether similar cases may also be partially attributable to Type 1 Chiari has not been studied in depth.
Chiari malformations primarily occur as a result of congenital disorders. However, these malformations may be asymptomatic until triggered by physical trauma, such as an automobile collision. Furthermore, a growing body of evidence is suggesting that physical trauma can actually be the sole cause of a Type 1 Chiari malformation.
If you are seeking damages due to an automobile crash or other physical trauma which you believe may have resulted in symptoms associated with Chiari malformation, you may encounter insurance companies arguing that the condition or even your symptoms were pre-existing in order to deny you compensation. For this reason, legal representation can make a crucial difference in combatting these sleight-of-hand tactics.
Over the last few decades, numerous studies have provided an increasing body of evidence linking whiplash and car accidents with Type 1 Chiari malformations. This evidence not only shows that such physical trauma can trigger otherwise asymptomatic Chiari malformations, but that such trauma may even be capable of causing the disorder outright. These are the articles the medical expert retained by your accident lawyer will be relying on in forming the opinion that the Chiari malformation symptoms were induced by a car accident.
In 1998, a study from Mampalam titled "Presentation of Type 1 Chiari Malformation after Head Trauma." In this study, Dr., Mampalam describes the case of a 13-year-old girl who was hit by a car at 25 miles-per-hour. The young girl lost consciousness and suffered cardiopulmonary arrest. The study reported the girl had a central brain herniation and required intercranial pressure monitoring and treatment.
In 1999, a groundbreaking study by Milhorat found that nearly one quarter of Chiari patients reported that some type of trauma precipitated their symptoms. In this article, the authors concluded that there is "limited information regarding the epidemiological features of Chiari I malformation. The anomaly is defined as a rare disorder, and female subjects outnumber male subjects by a wide margin…. Approximately 25 percent of patients cited trauma as the precipitating factor. The most common mechanisms were whiplash injuries and direct blows to the head and neck, which raises the possibility that certain types of trauma accentuate tonsillar impaction or result in subarachnoid hemorrhage that destabilizes a marginally compensated CSF system."
In 2008, a report from the University of Toronto (Wan et al) backed this up, showing that head and neck trauma frequently preceded Chiari symptoms in a group of 85 patients.
In 2010, a study by Freeman et al found that Chiari Malformations are significantly more prevalent amongst patients suffering from whiplash from car crashes compared to those reporting neck pain without recent trauma.
If you or someone you know has recently been in a car crash and experienced whiplash, it is highly advised by one of the authors of this most recent study that you immediately see a healthcare provider - as there could be a more serious condition (such as Chiari) present as well. Depending on the severity of your symptoms and the recommendation of your doctor, a standing MRI could be necessary to detect the presence of Chiari.
Should a diagnosis of Chiari be attained, you may seek compensation but the insurance industry will most likely fight to minimize or deny any payment to assist you with treatment and/or recovery. You should be prepared ahead of time and know that some of the criteria which could be at stake include whether you:
- Were asymptomatic before the event
- Sustained significant injuries to your head or neck
- Manifested the symptoms within six months
- Have another pre-existing condition which offers a better explanation
The diagnoses for Chiari malformations are typically made through a combination of patient history, medical imaging, and neurological examination. While the exact procedure used may depend on what your doctor recommends, Magnetic resonance imaging (MRI) is considered the best option and superior to CT scans. This is especially the case for standing (rather than lying-down) MRIs, which recent studies show have detected a large number of Chiari malformations which would have otherwise been overlooked in patients who recently experienced physical trauma from whiplash.
While unfortunately there currently is no cure for Chiari malformation, there are several options for treatment which can help alleviate its symptoms, including surgery in more extreme cases. Before pursuing any of these options you should consult with your physician and ensure the treatment is right for you. In many cases these treatments are not suggested unless the symptoms are severe enough as they come with risks and complications as well.
Some of the options for treatment include:
Chiropractic spinal adjusting: Based on a survey of the available literature, this method has achieved mixed results: sometimes alleviating symptoms, and sometimes worsening them. We strongly recommend you consult with a physician and consider all available options, including Atlas Orthogonal chiropractic treatment, in order to decide whether this option is right for you. Anyone pursuing this treatment is advised to pick a specialist who is familiar with the unique requirements Chiari may present.
Decompressive surgery: Although this method has also been used with some success, it can have serious complications and is only used in extreme cases. By removing the bone at the back of skull and spine, this surgery aims to relieve compression of the brainstem and spinal cord, and restore the normal flow of fluid. For a more in-depth description of the procedure, recovery, benefits, and drawbacks of this type of surgery, please consider consulting additional sources such as this one and make sure to consult a physician.
Detethering the Spinal Cord: A small number of neurosurgeons believe that this alternative approach to decompressive surgery is a more effective way of relieving the compression of Chiari and eliminating the need for surgery. This approach is significantly less documented in the medical literature, and like other treatments for Chiari is not without risk. If you are considering this approach, make sure to consult with a qualified physician.
Our lawyers believe the key to winning a Chaiari malformation lawsuit (or getting a good settlement) is getting the victim's treating doctor onboard as an expert witness. The insurance company knows that if the treating doctor supports your case, it is much more difficult for the defense to sing its' usual song to the jury that condition is not related to the car accident.
If you recently suffered a Chiari malformation in a car accident, contact the personal injury attorneys at Miller&Zois to discuss whether you may be entitled to financial compensation for your injury. Call us at 800-553-8082 or click here for a free online consultation.