Chiari Malformations
Abstract III
Craniocervical Decompression, Cerebral Blood Flow and Neuropsychological
Dysfunction in FMS and CFS
Michael J. Rosner, M.D., F.A.C.S., F.C.C.M., Sharon E. Guin, C.R.N.P.,
Alice Johnson, R.N and Sheila D. Rosner, B.S.N., M.S.N.
Acknowledgements
The authors gratefully acknowledge Drs. J. M. Mountz and E. San Pedro
of the Division of Nuclear Medicine at the University of Alabama at Birmingham
for SPECT scan data.
INTRODUCTION: Because others have reported that
rCBF measured by SPECT scan was abnormal in patients with fibromyalgia
syndrome, the hypothesis was tested that rCBF as measured by SPECT scan
would improve after craniovertebral surgery in similar patients.
METHODS: Sixteen patients underwent pre-operative
rCBF SPECT scan who had been offered decompressive craniovertebral surgery
for Chiari syndrome, congenital cervical stenosis, or both. Detailed neurologic
history and physical examination were recorded in a prospective standardized
interview and examination. Pre-operative grip strength was measured and
the spinal cord was measured in its AP and transverse diameters. After
surgery, the interviews, standardized exams, grip strength, the spinal
cord measurements, and the rCBF SPECT scan were repeated. A parallel group
of patients later were given a more detailed questionnaire pre- and post-operatively
which included a number of questions related to neuropsychological complaints.
These were graded by the patients for severity using a 0-3 scale where
0 = no problem and 3 was severe, or a visual analog scale of 0-100 where
100 represented the worst imaginable degree of severity. A group of well
controls completed the same instrument.
RESULTS: Generalized bi-hemispheric increases
in rCBF SPECT measures of blood flow occurred in a statistically reliable
fashion. Generalized blood flow increases averaged 3 to 4 percent for
global cortical measures. The left frontal lobe increased by approximately
10 percent and the right occipital and parietal regions by 4 and 12 percent
respectively (p<.05--.001).
The neurologic complaints and exams of this group generally improved
with reduction in hyperreflexia, Babinski responses, improvement in strength,
etc. Grip strength improved from 23.2 ± 5.9 Kg. to 30.3 ±
11.4 Kg. (p = .03). In those patients undergoing cervical decompression
(n = 8), spinal cord area increased by as much as 40 percent (p < .001).
There is substantial improvement in Neuropsychological/neurocognitive
complaints after surgery, which parallels the improvements seen in a separate
but otherwise similar population of FMS/CFS patients.
CONCLUSION: Abnormalities of rCBF are present in a group
of FMS/CFS patients and provide an objective, physiological basis for
complaints of decreased cognition, and related “neuropsychological”
complaints. rCBF abnormalities may resolve with craniovertebral decompression
in parallel with neuropsychological improvement; these data strengthen
the concept of a physiological basis in the majority of patients for such
complaints. Since rCBF studies provide objective evidence for such complaints,
they may help guide the need for adjunctive therapy when rCBF abnormalities
resolve but complaints persist. However, persistence of such abnormalities
may suggest persist structural disease, or inadequate therapy and warrant
reinvestigation of the patient.
Presented at the National Fibromyalgia Research Association's Subgroups
in Fibromyalgia Symposium, September 26-27, 1999, in Portland,
Oregon.
