“…Based on established hydrodynamics principles, the intrathoracic pressures are transmitted toward the spinal and cranial compartments and further to the subarachnoid space. 25,26 Hence, one can hypothesize that in patients with CMI, the physiologic pressure transmission that normally exists between the intrathoracic and CSF compartments is exaggerated as a consequence of the steeper tapering of spinal canal, which, in turn, exacerbates the pressure differentials between the cranial and spinal compartments as well as their possibility of equalization, both of which are already altered by the herniated cerebellar tonsils. Intuitively, the elevated pressure differential may precipitate hyperkinetic CSF flow, and once a critical threshold is surpassed, a syrinx could be created.…”