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This was a 29 year old lady with severe headaches that were triggered by

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coughing.

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I was asked to render an opinion on this case because the tonsils really weren't

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peg, like they really weren't lying that low.

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But there was some crowding in the frame of magnum and you,

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you can see they're a little bit low here.

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They're about seven millimeters below the frame of magnum.

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But the patient had a pretty large s inx. Um,

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what was interesting about this patient is,

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is she didn't really have any cord signs of any kind,

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which I was kind of shocked at.

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She just had these headaches that were just terrible,

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that were triggered by coughing and sneezing. So I was like,

0:28

this is not a main reason I was asked to render pain is because someone thought

0:31

there could be maybe a C S F leak and this is acquired chira. And I was like,

0:34

I don't think so. Um,

0:36

we did a contrast enhanced brain m r i and there there was no secondary signs.

0:40

Um, but in, in the end, this patient did undergo a flow study.

0:43

So this is the sagittal Fiesta from that flow study.

0:45

You can see there's crowding the frame of magnum with very little room around

0:48

the brainstem, and there was literally no flow through the frame magnum on the,

0:52

on the sagittal flow study here. Um, and, and again, at this point we,

0:55

we turned our banks very low just in case, um, that we were missing something.

0:59

But we, we saw basically no flow through the frame of mag at that point.

1:02

We decided she, she needs decompression. So she got a suboccipital, cranium,

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neuroplasty, and um, a few months later the steerings is completely gone.

1:11

So it, it, that had to be what the problem was,

1:13

even though the tonsils weren't peg, like, I mean, and I,

1:16

I show that because the, we, we do fixate on that peg like tonsil thing.

1:19

And I think the flow study can really help you decide if,

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if it is a significant chira or not. If you don't see those peg like tonsils,