Chiari I -- Malformations  -- Most are Asymptomatic

Timothy C. Hain, MD. • Page last modified: March 3, 2021

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Asymptomatic chiari Chiari asymp2
Person with a clear Chiari on MRI, but without any symptoms or signs at all.  Another individual with 1cm Chiari, but with BPPV, and no central symptoms.

Most patients with Chiari Malformations are not operated upon, but rather most are simply watched -- once a year is generally enough. Having an MRI that shows a Chiari, does not necessarily mean that the person is sick. In fact, most of the time, Chiari malformations are asymptomatic. Someone with a Chiari need not assume that neurosurgery is in their future.  An abnormal MRI is not an indication for surgery - - surgery is done for illness, not for MRI findings.  

In our otoneurology practice in Chicago, it is rare for us to refer patients for surgery. Rather, we generally make arrangements to follow people on a yearly basis.   We look for signs of neurological deterioration -- downbeating nystagmus, especially on lateral gaze. Positional nystagmus. Headaches, especially on straining, of  cough syncope. If the individual has developed new symptoms, and their Chairi last scanned was a minor one (i.e.  between 5 and 10 mm) we rescan.   If there are new symptoms and the Chiari is 1cm or more, we send directly to onto a specialty neurosurgon

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