Intracranial Hypertension and Chiari Malformation

 / By Dr. Margaret Aranda / 

This is a medical discussion with graphic pictures. It is not suitable for minors. Parents, please use discretion.

Have you ever wondered why a baby's head is so, so soft? It really is. This is because all the bones on the brain are separated at birth. Only later do they close (See Image 1).

Image 1 Cranial Suture Lines.  They close Gradually with time, leaving us with a completely closed skull. At birth, this is quite the protective mechanism to house a growing brain with as much protection possible to safeguard internal injury. This is why a doctor always greets a baby by placing her hand on the baby's forehead, on the upper hairline to the skull. She is actually checking for a rise in intracranial pressure, ICP.   Image Courtesy brachialartery.co .

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 It is a great thing is that if there are brain abnormalities at birth, the baby's head can swell. It may not look pretty, but it is definitely a good thing that the 'sutures' between the bones are so soft and pliable (See Image 2). When the 'water' (ie, cerebrospinal fluid) in the brain can not properly drain, it builds up and in a baby's head to cause hydrocephalus . 

This comments found for survival.

Image 2. Increased Intracranial Pressure and hydrocephalus in a Baby: UNSEALED Growth Plates.  This is the normal mechanism that Ensures protection of the internal brain. Here the brain is swollen to 3x its normal size and the cerebrospinal fluid actually has "somewhere to go." Little 18-month old baby  Room to Begum  stimulated international awareness of a condition known as  hydrocephalus .  Room peculiar to fans everywhere, as she defied the odds of survival. She is of the world's most famous babies with extreme  Increased Intracranial Pressure . Abdul and Fatima Begum parents were unable to pay for healthcare in India's Room. Multiple surgeries were needed to decrease the head by pulling the suture lines you back together. This image is from about one year ago. I am unable to discover recent publicity.  Image Courtesy mirror.co.uk. 

Once the bone plates are sutured together in continuous bony formation, where is the only place to go for the brain?  The brain can only be pulled down into the spinal cord.

Chiari Malformation  is an anatomical deformation of the back of the brain, a separate entity called the cerebellum (vs. the 'regular' brain, the cerebral cortex that comments found us to process information, have imagination, feelings, and be who we are, consciously ). 

When either the Primary or Secondary Chiari malformation Occurs, the base of the brain is bulging down into the spinal cord (See Image 2) through a hole in the bottom skull called the foramen magnum.

Image 2  Chiari Malformation Type II .  It is definitely not normal for the brain to herniate down into the spinal cord. Parents are cautioned to listen to their children when they complain of  SYMPTOMS that could be due to Chiari Malformation.  Image Courtesy conquerchiari.com

Whenever I saw the parents getting a "Chiari Syndrome" diagnosis for their 5-year old child, I thought:

"These parents really listen to their child."

                           ~ Dr. Margaret Aranda

History:  Chiari Malformation is named after  Austrian Pathologist Hans Chiari (1851-1916) . He was the first person to Widely distribute the information on this brain abnormality and assign initial CLASSIFICATIONS C lassificatio of  Types I - III; These were published in the year 1891 (See the original paper  here ). Born in Vienna, Austria, Dr. Chiari died On May 6, 1916 in Stasbourg, France. He is still beloved today, September 4th with Chiari celebrated as the Day. 

Chiara's father was JBVL Hans Chiari, MD., A famed gynecologist who described prolactinoma. JBVL Chiari, MD was Chair of Departments of Gynecology in Prague and Vienna, and wrote a book on the history of pathology. 

It is finely pointed out that Hans Chiari gave credit (unlike so many others) to  colleagues  who Formulated the concept of 'naming' and describing this cerebellar abnormality before him.  I. Solt  tells the story in 2010 in a Journal Editorial, which is far better than anyone can do, at this point ~

The title of this piece is:

"Chiari malformation eponym- time for historical justice"

"....... In 1883, the British anatomist John Cleland (1835-1925) was the first to publish a brief description of an infant with spina bifida and hydrocephalus 1. In 1891 and 1895, Chiari published feelings extensive and thorough landmark descriptions 2 ,  3 , which contained comprehensive neuropathological evaluations of the malformation. in 1894, Julius Arnold (1835-1915) published a case report of an infant with a sacral teratoma, but without hydrocephalus, and described "a ribbon of tissue that protruded through the foramen magnum ' 4 . Arnold did not include in feeling report a pathological evaluation or further information, and did not cite the previous works of Cleland and Chiari, while Chiari had cited Cleland 1  in feeling first publication 2 , and went on to cite Cleland both 1  and Arnold 4  of feeling second publication 3 . Both Arnold Chiari and the reports published them in German and it is highly unlikely that Arnold was unaware of Chiara's first publication .... "

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I'll just add that John Cleland also had a penchant for poetry. 

Chiara's 1891 report drew much more attention for its highly acclaimed nature, as Cleland's descriptions were deemed to be rather incomplete. Finally, let's not forget Jean Cruveilhier (1) was a pathology illustrator, who drew images of several key brain and spinal cord pathologies without putting them into a formal classification; he did this 50 years before Chiara's original paper was published. A review and history of Chiari was published in the  British Medical Journal, 2000 , partially entitled, "Cleland Cruveilhier Chiari 'Syndrome to show the many and previous contributors to describing this syndrome.

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The cerebellum is the brain's primary organ responsible for your body's balance. Vision is also processed in the cerebellum. There is no known cause of Primary Chiari. However, "Acquired" or "Secondary" Statistically Chiari is more likely to occar if:

(1) Embryonic during fetal development was abnormal replication during cell division of the spinal cord (ie, a neural tube defect); or

(2) The bony-structured opening that leads to the base of the skull is abnormally small or otherwise shaped so that the brain just Becomes 'too crowded' in its own skull. 

The foramen magnum is the only place in the brain that is a last resort to absorb small changes in Increased intracranial pressure (ie, the pressure inside the skull, ICP).  The patient typically presents with thes the complaints, seen in Image 3:

Image 3. Symptoms of Increased Intracranial Pressure.  For Hasta with Chiari Malformation, headaches are so Commonly and painfully felt. This is why it is importante to listen to your child's complaints.  Image Courtesy I ausmed.co. 

One can imagine several things that would make this situation is either better or worse. Factors that make Chiari SYMPTOMS worse Causes include anything that an increas in ICP. Just think of a 'mad as a hatter.' Anything that makes the face red also increases blood supply to the brain, worsening SYMPTOMS:

Makes Increased ICP Worse                            

• Standing on your head
• vomiting
• Screaming
• Holding your breath
• High blood pressure
• Tachycardia (fast heart rate)
• High salt diet
• Increased water / fluid intake
• laying down
• Laying down with your feet up

Eventually, the brain swelling Becomes incompatible with life. For lovers of increased & ICP Interventions are Necessary. Patients that live with Chiari Malformation frequently live with lifelong dread at all the swings of increased & ICP is going on in their head:

Increased ICP Makes Better:

• Sitting upright with head
• Avoid vomiting
• Lowering your blood pressure
• Slowing your heart rate (but be careful)
• Breathing fast
• quiet
• Having the surgeon to drain the fluid

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NATIONAL BOARD EXAM QUESTION:

What is the worst-case scenario, and the favorite question from the American National Board of Medical Examinations (NMBA)? 

"Which of the following is found in a patient with intracranial hypertension lovers?"

1. systolic hypotension

2. Decreased carbon dioxide levels on arterial blood gas analysis

3. Increased Heart Rate

4. Decreased Respiratory Rate

Answer in "Type K" format: 

A. 1 and 3 are correct

B. 2 and 4 are correct

C. Only 4 is correct

D. 1, 2, and 3 are correct

4 E. All are correct

Go ahead and Answer before you read on.

The reasoning behind the answer to this question is the famous  Cushing's triad  that every medical student, resident and Fellow for American National Board Exams should know :

Image 3 Cushing's triad.  All medical students, interns, and residents need to know that if you have a patient with liver failure and on the Liver Transplantation List, you better be watching for the classic signs that your patient is about to herniate into the spinal cord below the foramen magnum.  Cushing's triad is the classic formula that every doctor should know. The answer to the above question is "D." The choices given in 1 - 5, are deliberately set out to draw the fine shades of decision-making required of a physician. So when your doctor 'thinks,' I should really be 'thinking hard.'

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MEDICAL MIRACLE:

Leaving you on a positive note is importante to me. So I'll do my best to show you a medical 'miracle' at the end of each Article. Here, let us look at the beloved Baby Rooke today: after one year of surgeries to decrease every head circumference, she smiled for the first time (See Image 4):

Image 4. One Year Later.  Room to smiling in 2014. A survivor of 'water on the brain, "hydrocephalus and the Resulting Intracranial Hypertension. Reportedly, the local community cast pressure on the parents, Particularly the mother, saying she should give the baby up for adoption each in a religious home or place of compassion. The mother refused, Desiring the closeness of wanting her baby to die on every lap. Not anywhere else.

Epilogue: To be provided with updates, I registered as a medical professional. That allowed me to access it in the July 2014 update to the article on Room,  here . Additional information on the Baby Room is not available on my research effort. I think it is reasonable to assume that she has passed away. Another possibility is that the family was under too much pressure and stress, and went out of the mainstream public. The Baby Room is still, and always will be, a medical miracle. She defied the doctor's assessments time and time again. She smiled. She laughed. She knew every mother. It is a testimony of the strong love between a mother and a daughter, no matter which way you tell this story. That is the second miracle to behold.

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So let us continue to the increased awareness. 

Additional information on Intracranial Hypertension : en Español  here  and here ;  İngilizce  and  Chinese too.  

And spread the word on  Chiari Malformation :  en Español and İngilizce.  

Here is  good information  for patient advocates, caregivers and medical professionals.

Thank you for reading my writings .

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REFERENCES:

(1)   Cruveilhier J .  L'Anatomie pathologiqu du corps humain, descriptions avec figures have coloriées lithographiées; Alterations morbides diverses et dont le corps humain susceptible . 2 Vols. Paris: Bailliere, 1829-42. 

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RESOURCES:

I CHIARI

INTERNATIONAL:

International Chiari  Association  

Twitter  @ıntlchiariassn 

~ I nternational Association Chiari on Twitter. 

~ International Chiari Association on Facebook.

II. hydrocephalus

INTERNATIONAL:

Hydrocephalus Association  / Twitter @hydroassoc

Sea Download App for hydrocephalus

~ Hydrocephalus Association  on Twitter.

~ Hydrocephalus Association  on Facebook.

III. Intracranial Hypertension

INTERNATIONAL:

Intracranial Hypertension Research Foundation  / @ıhresearchfound

~ Intracranial Hypertension Research Foundation En Español

~ Intracranial Hypertension Research Foundation  on Twitter.

~ Intracranial Hypertension Research Society  on Facebook.

MEDICAL  DISCLAIMER:  This article is for information Purposes only and is not intended as medical advice, treatment or cure. Always consult a qualified professional when seeking medical care for your medical complaints. In the USA, call 911. In Spain, Portugal and the UK, call 112. 

Thank you for Increasing awareness of Intracranial Hypertension and Chiari Malformation.

Charity: Who Should Give, What should You Give, & Why Should You Give?

06/08/2016 at 11:30 am (PST) by Grassroots Talks Radio | Moms and Family Podcasts
Host: Dr. Allen Brown
Speaker: Margaret Aranda, MD, PhD

Dr. Aranda Says:

Let's start out by asking just one question: 

"What does James 1:27 say?"

Image 1. Grassroots Talks Radio with Dr. Allen Brown and Dr. Margaret Aranda on "Charity." The Call-in Phone Number for Listening in, Asking Questions, or Adding Comments is:
(657) 383-0162, USA. 


Charity Who Should Give, What should You Give, Why Should You Give? 06/08 by Grassroots Talks Radio | Moms and Family Podcasts: The act of Giving ~ Is it Godly to give? Are you being tricked when you give? What do the people who receive it, do with the gift? 

Listen to Dr Margaret Aranda give you an educational and inspiring talk on The Word of God straight from the Bible. And understand the good works that are being done in the world, all because of one word: "Charity." 

Go now, spreading this Word of God to more nations. We are an International undertaking with this TalkRadio Show, so we rely on each and every one of you to continue to spread the Word of God. Amen. 

What if God was One of Us?

by Dr. Margaret Aranda

What if God was One of Us? 
We discussed this today on The Dr Margaret Aranda TalkRadioShow
With Grassroots and Founder Dr Allen Brown

Have you ever walked by a homeless man (a dirty, filthy slob), or just stepped over his body while you are texting on your cell phone? You see scores of pedestrians doing it before your arrival, and it continues behind you on and on, into infinity. Or perhaps you are at the airport waiting for a ride, and he is sleeping on the sidewalk. You turn your back, as if that is going to make him go away. You deliberately choose to not look back again.

Video 1. What if God Was One of Us? Why are we here? Aren't we here to help others? 




What if that was Jesus? Am I the only one that thinks this way? Am I the only one that remembers Christ's sayings out of His own blessed mouth? 

Matthew 25:40*:
The King will answer and say to them, ‘Truly I say to you, to the extent that you did it to one of these brothers of Mine, even the least of them, you did it to Me.’

and on the other side of the coin, we have..........

Matthew 25:45*

Then He will answer them, ‘Truly I say to you, to the extent that you did not do it to one of the least of these, you did not do it to Me.’

If you are not acting out of the love of Jesus, you lose. And He reads your heart, so you can't fake it. 

BTW, did you even know that "doing" and "not doing" the right thing to "the least of these" are BOTH sins? 

Image 1. A Random, Sleeping Homeless Man. The population just passes him by, themselves immune and deadened to his slow destruction. This has gone on for decades, and in city after city, rain, snow, or shine. Are the people destroyed for their lack of knowledge?


We have to get "out of ourselves!" We must be IN this world, but not OF this world! We are NOT a part of worldly corruption. We do NOT watch porn while our wife is not looking! Nor do we stash that bottle of bourbon under our desk to drink when we are alone late at night. We do NOT lust for another man's wife, do we? We DO honor our parents, right? 

Do you go to "church" and look at your watch the whole time, waiting with baited breath for it to just end already? And one you are in the parking lot to leave and have a business brunch at the nearby Hotel, are you sweating and actually honking your horn in the parking lot to get out? Is that a little old lady I see in that car you're honking at? YES! What? 

You HYPOCRITE! You gamble away tens of thousands of dollars in Vegas, yet you cannot spare the little change from your own pocket for a homeless man with cracked lips on the sunny sidewalk? What? WHAT? You FOOL! 

There is only ONE RELIGION. Give. Love. Love thy neighbor.

It is James 1:27 ~ Pure and undefiled religion in the sight of our God and Father is this: to visit orphans and widows in their distress, and to keep oneself unstained by the world.

Ask yourself: Are you corrupted by this world? Americans who have a bed, a roof, and a refrigerator already won the LOTTERY. We have more than 75% of the rest of the WORLD.
So stop complaining. Stop whining. Get out your wallet and write a check. Do good. 

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To place a homeless single woman in her own apartment for safety, to help Foster teens who turned 18 and whose parents no longer get $ from the government, leaving them homeless, for veterans, and the disabled, please give:

Mail check or money order to: 11432 South Street;  Suite 206; Cerritos, CA; 90703.

Visit our website to gain further information: http://grcnconnects.wix.com/families

We are a 501(c) non-profit. Your donation may be tax-deductible; talk to your accountant.

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Thank you and God Bless You.

The homeless and the youth thank you, too. 

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follow Dr Margaret Aranda here:
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Age 1: A Baby on the Edge

by Dr. Margaret Aranda

It was my Father.  I knew it was him, and I had no fear.

My Father held me, and his arms and his scent were familiar to me.  In fact, I can still smell him if I close my eyes and reminisce just a little bit. There.  I can do it now.  I know he is gone but it's almost like he is just next door, always there.

It was a summer day, sun beaming into my grandmother's San Antonio living room.  The smell of bacon and coffee emanated throughout the room, boastful of the electric percolator that gurgled and puckered its congenial hellos to the morning.  My uncles and aunts crowded the room, as well as my cousins, and the room hummed with conversation here and giggles there.  

Children were running about, in and out the front door, boisterously slamming the screen door behind them.  The reason why I remember who was there, is because I was looking down on them all.

I could sit straight up, and no doubt my curly dark brown hair was tossed all about.  I didn't care about anything except my Father.  He told everyone,"Watch!"  My Mom echoed the usual, "Oh no, honey, your'e not going to do that thing again, are you?"  She was simply horrified and really, she was quite disgusted.  MORTIFIED! My Dad told her to relax.  She just stared at us. I didn't care. I just couldn't wait!

Image 1. Up! Up! Up! I closed my eyes and tried with all of my might to hold in the excitement.  I was sitting in his hand now, his right hand.

Slowly, ever so slowly, as I was Sitting on The Edge of his hand, he started to lift me up. He lifted me Up! and Up! and Up! and Up!  Straight up to the ceiling we went, and I closed my eyes and I held in the burst of exclamations as tight as I could.  Up! Up!  I went, dreaming of everything and dreaming of nothing.  I was On The Edge, and that was where I was going to stay.  I had no fear.  

My Father would hold me up, just like he always did.  

I could do this.  With him there, I knew I could do it. I held out my arms for balance. I straightened my back. I held my breath, ever so slightly.

My Father had me.  

He was my Father.  

I knew it was him, and therefore, I had no fear.

We should feel the same confidence in God.

After all, we are His children. 

And He is our Father. 

Amen.