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Karl Clebak

Case Presentation 75 year old with rt shoulder numbness, lest

sided trapezius muscle soreness fasciculation in left biceps. No headaches, dysphagia, dysphonia.

Read There are low lying cerebellar tonsils, with

protrusion approximately 11 mm below the basion-opisthion line. The posterior fossa is small. There is a large syrinx in the visualized portion of the cervical spine extending from the mid body of C2 inferiorly. The syrinx is incompletely imaged on this study. These findings are consistent with Chiari I malformation.

Chiari Malformation Type I - fourth ventricle above foramen magnum, upper

part of cervical cord displaced caudally, seen in pediatrics

Type II - most common; cerebellar vermis (+ cerebellar tonsils), medulla + fourth ventricle herniated into upper cervical canal; described here

Type III - cerebellar vermis, medulla + fourth ventricle protrude exteriorly as occipital encephalocele

types III + IV - progressive caudal displacement of cerebellar vermis, pons + medulla below foramen magnum

Age affected 40-60 years symptoms in adolescence or adult life; apparent at

birth for types II and III

Associated Symptoms syringomyelia, syringobulbia, deformities of vertebrae,

cranial nerve palsies, hydrocephalus and hydromyelia associated with lumbosacral meningomyelocele obstructive sleep apnea

related to loss of pharyngeal sensation

Presentation Chief Concern

cough-induced headache and neck pain, nausea, vomiting; occasionally transient hydrocephalus, unsteadiness of gait, dysarthria, dysphagia, syncope (compromised medullary function)

History of Present Illness pain at cranial-cervical junction aggravated by head movement or Valsalva

General Physical: rapidly increasing head circumference, lethargy, irritability

More Physical

Surgery Surgery:

shunt to direct ventricular fluid most commonly ventriculoperitoneal shunt absorptive surface of peritoneum may be inadequate in very

small infants - ventriculoatrial shunt CSF may need to be shunted to pleural space

Bonus Case Hip Pain

References Arnold-Chiari malformation. Dynamed. Updated

2007 Jul 05 02:25 PM. Accessed 31 March 2008.