Dizziness is the rotation of the person himself or his surroundings and is a very common complaint. Dizziness constitutes 25% of patients who apply to the emergency services of hospitals. Dizziness and imbalance complaints (Arnold Chiari) are the leading complaints of cerebellum prolapse. There are 4 types of cerebellum prolapse, the most common being Type-1.
Cerebellum prolapse is the congenital narrowing of the bone structures around the cerebellum or the extension of the cerebellum into the spinal canal in the neck due to adhesions in the cerebellum, closure of the water channels in the cerebellum.
Although the disease is usually seen between the ages of 25-35, it is rarer in children. In recent years, the diagnosis is made easier and faster with the frequent use of imaging diagnostic methods. Although the hereditary transmission of the disease is well known, it is more common in women than in men. In 40-60% of cerebellum prolapses, there is fluid (syringomyli) in the spinal canal.
In these patients, complaints and findings are very high, while 30% of the patients do not give any complaints, while 70% apply to different outpatient clinics of hospitals with progressive and serious neurological complaints. These patients do not have specific signs other than dizziness, headache, neck pain, and vision complaints after movements that increase intracranial pressure such as coughing and sneezing. These patients apply to many polyclinics such as Neurology, Neurosurgery, Psychiatry, ENT, Ophthalmology, Chest Diseases, Cardiology, Internal Medicine, Physical therapy and emergency services.
Clinical findings seen in patients;
1: Auto-neurological signs: dizziness, imbalance, tinnitus, hearing loss
2: Headache due to increased intracranial pressure, this pain starts from the nape and radiates to the back of the eyes and to the neck and shoulders .
3:Complaints due to fluid accumulation in the spinal cord nerve are seen in 40-60% of patients. Muscle weakness, loss of sensation in the arms, and dexterity and coordination disorders in the hands are seen.
4: Ocular findings: pressure and pain behind the eyes, blurred vision, double vision, inability to look at the light and the sun.
5: Cerebellum complaints. imbalance, coordination and dexterity disorders, difficulty in swallowing, hoarseness, tremors in the hands, sleep apnea
Cerebrospinal surgery specialist Prof. Dr. According to Hidayet Akdemir, it is recommended that patients suffering from dizziness and headaches that do not go away should be examined by a neurosurgeon and the necessary imaging techniques (brain MRI, brain CT, audiometric tests) should be performed for diagnosis.
Do not confuse prolapse of the cerebellum with other diseases
Brain and cerebellum vascular occlusions, demyelinating diseases, polyneuropathies, spinal cord tumors, spinal cord vascular tangles (AVM, cavernoma). Nerve compression in the neck vertebrae, rheumatic and cancer diseases and sleep apnea. Psychogenic diseases (depression, panic attacks, stress, anxiety)
How to treat dizziness (vertigo) and imbalance
The priority in treatment is the treatment of the underlying primary disease. For example, ear-related dizziness is treated by the relevant ENT physician with medical or surgical methods. Cerebellum-induced dizziness (vertigo) and imbalance are treated by neurosurgeons (Neurosurgery and Neurology physicians, psychogenic ones are treated by psychiatrists.
Dizziness (vertigo) and imbalance related to neurosurgery (vertigo) and imbalance of cerebellum are treated in n-treatment as in diagnosis. There are many innovations.
The basic question of treatment is to find the answer to whether the cerebellum prolapse gives the patient a complaint or not.Therefore, the patient’s complaints should be based on the MR findings rather than the prolapse.Unfortunately, drugs have no place in the medical treatment of this congenital anomaly. Before treating the disease, first of all, the type of disease should be defined correctly. The aim in surgical treatment is to relieve the pressure in the brain structures that are stuck in the nape region, to remove the obstacle in the flow of the cerebrospinal water and to ensure the flow of this water. Surgical success is excellent when the correct technique is applied to the patient.
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Treatment of cerebellum prolapse in children. Generally, those with progressive neurologic findings should be treated for compression findings of the brainstem and cerebellum.
Not afraid of dizziness (vertigo) and imbalance complaints, successful results are obtained with the correct investigation of the cause of this disease, the use of appropriate diagnostic methods and the correct surgical treatment method.
