Narrative: Chiari malformations, or cerebellar tonsillar ectopia (CTE), along with cranio-cervical syndromes (CCS) and cranio-cervical instability (CCI) may contribute to brainstem compression presenting as a complex clinical conundrum for physicians that treat the cranio-cervical junction (CCJ) as part of their clinical practice. Patho-anatomical features causing the constellation of symptoms that confound efforts at diagnosis by mimicking other disorders are discussed. The lack of knowledge creating misdiagnoses, misunderstanding of how to treat, and possible dangerous treatment outcomes, in surgical and non-surgical care, is addressed as it permeates through medical and musculoskeletal physicians such as chiropractors and physiotherapists. Discussion on where the limitations of surgery and contraindications to manual therapy fall in comparison and contrast to the oft sought out Atlas Orthogonal (AO) chiropractic approach is also given. Scores of patients accessing online information increasingly to ascertain treatments for symptoms their practitioners can neither explain nor alleviate presents a very uncertain and possibly dangerous picture for sufferers. This report provides a structured approach to the assessment of such patients with recommendations for safe and effective clinical intervention and care. The lessons are taken from a series of 15 cases purposively selected from the clinics of 2 AO practitioners known to each other, one in Australia and the other, USA.
Author keywords: Chiropractic; Brainstem; Chiari malformation; Upper cervical; Craniocervical junction; Cerebellar tonsillar ectopia; Cranio-cervical instability; Atlas Orthogonal; Case series
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