Chiari & Personality Changes

March 31, 2010 - Now that I have been writing a regular column for four years, it is becoming increasingly difficult to find new and fresh topics of interest. Before I go further, if you would like me to write about a topic I have not previously addressed please let me know. Anyway, I sometimes get ideas for topics by reading the Yahoo Groups Chiari posts. This month, I came across a post that talked about personality changes with Chiari. I found it of personal interest because prior to my own decompression, I occasionally exhibited an uncharacteristic short fuse with those closest to me and after decompression my mood has been consistently upbeat compared to any other period in my life. So, I thought it would be interesting to look into this topic a bit further and report my findings.

Having looked at the title of nearly every paper ever published on Chiari from having done numerous medical literature searches over the years, I knew I was unlikely to find any direct information of interest by performing a search on Chiari and personality changes or disorders. Nevertheless, I did one for the sake of completeness and as anticipated my suspicions were confirmed. So, I conducted a couple of searches on personality changes associated with related diseases/conditions, namely, idiopathic intracranial hypertension or pseudotumor cerebri and posterior fossa tumors/lesions. These diseases/conditions like Chiari result in compression to the various structures of the hindbrain (upper spinal cord, brain stem, and cerebellum). Idiopathic intracranial hypertension or pseudotumor cerebri is a condition where the pressure inside the skull is elevated due to unknown causes. Tumors or lesions in the posterior fossa (brain stem and cerebellum) also resemble Chiari and can consist of a family of problems including cancerous tumors and cysts (Danny-Walker probably being the most common type of cyst).

It didn't take me long to find a couple of interesting papers that lead me to hypothesize that personality changes may also be attributable to Chiari in certain instances. The first paper appears in the journal "Psychiatry" by Salzbrenner and Conoway1 of the Portsmouth United States Naval Medical Center. The authors describe a case study involving a woman who presented at the inpatient psychiatry department following a failed suicide attempt with a history of bipolar II and borderline personality disorders. Bipolar disorder is when an individual's mood swings back and forth from depressed to manic states. In bipolar II, the affected individual never really reaches true manic states as observed in bipolar I disorder. Borderline personality disorder is characterized in part by swings in relationship moods from love to hate. The attending physicians concluded that the patient did not suffer from bipolar disorder at all. Rather they diagnosed her with post traumatic stress syndrome which shares symptoms in common with bipolar disorder. Interesting however was the fact that the patient was also diagnosed with pseudotumor cerebri of which the attending physicians felt contributed significantly to her psychiatric symptoms. With proper treatment, the patient responded well.

Several different cases are reviewed in the second paper by Pollak2 et al which comes from Tel-Aviv University. Three patients had tumors and two had Danny-Walker cysts. Symptomatology included psychosis, major depression, and personality disorders. The investigators attributed symptoms to a derangement in the balance of important neurotransmitters.

So what does all this mean exactly? If your mood or personality is self-perceived as different or expressed to you to have changed by others, could Chiari be the cause? The answer is maybe but not necessarily. Personality changes can have their roots in many causes. These changes can be caused by medications and supplements, improper diets, and traumatic events to name a few. If the change is felt to be problematic, it is important to seek proper professional health care assistance. Don't expect time to resolve it. Don't experiment by discontinuing prescribed medications or initiating unprescribed dietary supplements. Only health care professionals can sort through the maze of potential factors and causes and administer or prescribe effective treatments.

1Psychiatry (Edgmont). 2009 Aug;6(8):29-32.
2Int J Neurosci. 1996 Nov:87(3-4):119-26.

Ed. Note: The opinions expressed above are solely those of the author. They do not represent the opinions of the editor, publisher, or this publication. Mr. D'Alonzo is not a medical doctor and does not give medical advice. Anyone with a medical problem is strongly encouraged to seek professional medical care.