Forty-two-year-old Tonya Daniel began suffering severe headaches when she was a teenager. Then they stopped, recurring only on occasion. Two years ago, the pain returned, and by 2012 she was living with a headache 24 hours a day.
After reviewing the results of her MRI, her primary care physician in Lawton, Oklahoma, diagnosed Chiari malformation and recommended that she see a neurologist. Like many modern, informed patients, she took charge of her health care and self-referred to a neurosurgeon.
“I started with a neurosurgeon in Oklahoma City – about an hour and a half away,” she says. “I wasn’t pleased so I saw another one in Colorado but didn’t feel comfortable with him either. On MedHelp’s online Chiari health forum I met a woman who had been treated by a neurosurgeon in Houston and was very pleased with her experience. So I scheduled an appointment."
Daniel made the eight-hour trip to Houston and was seen at the Face Pain, Trigeminal Neuralgia and Chiari I Clinic at Mischer Neuroscience Institute at Memorial Hermann-Texas Medical Center by Dong Kim, MD, director of MNI and professor and chair of the Vivian L. Smith Department of Neurosurgery at McGovern Medical School at the University of Texas Health Science Center at Houston (UTHealth). “Chiari I is a very specific syndrome that occurs in people whose posterior fossa is more shallow than normal or is situated lower in the brain,” Dr. Kim says. “A portion of the cerebellum starts herniating downward, causing pressure on the spinal cord, which in turn causes symptoms.”
Type I Chiari can be asymptomatic, but patients may also experience numbness and tingling of the hands, balance problems, and blurry vision in addition to headaches. When symptoms become severe, they can lead to hand weakness and fainting, or near fainting.
During the initial office visit, they discussed surgical options and what to expect during her recovery. When working with his patients, Dr. Kim listens carefully to the descriptions of their symptoms. “It’s most important to correlate the clinical picture and what the patient is feeling with what we’re seeing on MRI,” he says. “There’s no effective long-term treatment for Chiari malformation other than surgery. Medications may help at the beginning but eventually, as the symptoms worsen, they begin to fail.”
Dr. Kim took Daniel to surgery on May 22, 2013. “It’s a straightforward procedure,” he says. “The goal of surgery is to provide more space in the foramen magnum without affecting the brain. We open the skull and widen the dura, the outermost of the three layers of meninges surrounding the brain and spinal cord. We remove the herniated tonsils, which has no effect on the patient.”
Hospitalized for three days, Daniel returned to Oklahoma after spending an extra night at a hotel in Houston before making the long trip home. She returned to work six weeks later.
“When I first met Dr. Kim, he said, ‘I can help you and you will be better,’” she recalls. “But I never dreamed I’d feel this much better. I was caught in a very bad cycle. The headaches were keeping me awake at night and I would go to work exhausted, come home, take a shower and go to bed. Now my energy level is back, and I’m going strong.”
Daniel describes her experience at Mischer Neuroscience Institute as “phenomenal, from the lady who checked me in to the patient care tech who wheeled me out. Dr. Kim and his team are out of this world. I’ve never met so many healthcare professionals who so genuinely care.”