Chiari I Malformation Case Study
Chiari I malformation with acute neurologic deficit after craniocervical trauma: Case report, imaging and anatomic considerations
David E. Adler, MD, Josha Woodward, BS
Legacy Emanuel Hospital
In patients with Chiari I malformation, the occurrence of acute neurological deficit after craniocervical trauma is rare. This case describes a 41-year-old male who sustained a single blow to the face, fell and struck the occiput. On admission, neurologic exam revealed a profound paraparesis, upper extremity diplegia, and apnea, which required intubation. Computerized axial tomography of the head showed a small amount of contra coup left frontal traumatic subarachnoid hemorrhage. MRI of the brain and upper cervical spinal cord performed within 19 hours after admission was negative except for the presence of a Chiari I malformation. All other radiographic studies at the time of admission were normal.
The constellation of severe neurologic deficits after relatively minor craniocervical trauma in patients with Chiari I malformation has been …show more content…
New Fairfield, CT, national Organization of Rare Diseases, 1999) and its incidence is uncertain. However, an incidence of 0.77% is suggested after a review of 22,000 MRIs demonstrated cerebellar tonsillar ectopia of greater than 5 mm below the level of the foramen magnum (Aboulezz et. Al. Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: A quantitative approach with MR imaging. J Comput Assist Tomogr 9:1033-1036, 1985). Presenting symptoms range from severe headache, nausea and vomiting to numbness, tingling and weakness. Symptoms may also relate to lower cranial nerve palsies, causing dysphagia or dysphonia. Neurologic signs may include spasticity, motor and sensory deficits. Neurootologic or neuroophthalmologic findings ranging from nystagmus to impaired visual acuity and papilledema (?) may also be
David E. Adler, MD, Josha Woodward, BS
Legacy Emanuel Hospital
In patients with Chiari I malformation, the occurrence of acute neurological deficit after craniocervical trauma is rare. This case describes a 41-year-old male who sustained a single blow to the face, fell and struck the occiput. On admission, neurologic exam revealed a profound paraparesis, upper extremity diplegia, and apnea, which required intubation. Computerized axial tomography of the head showed a small amount of contra coup left frontal traumatic subarachnoid hemorrhage. MRI of the brain and upper cervical spinal cord performed within 19 hours after admission was negative except for the presence of a Chiari I malformation. All other radiographic studies at the time of admission were normal.
The constellation of severe neurologic deficits after relatively minor craniocervical trauma in patients with Chiari I malformation has been …show more content…
New Fairfield, CT, national Organization of Rare Diseases, 1999) and its incidence is uncertain. However, an incidence of 0.77% is suggested after a review of 22,000 MRIs demonstrated cerebellar tonsillar ectopia of greater than 5 mm below the level of the foramen magnum (Aboulezz et. Al. Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: A quantitative approach with MR imaging. J Comput Assist Tomogr 9:1033-1036, 1985). Presenting symptoms range from severe headache, nausea and vomiting to numbness, tingling and weakness. Symptoms may also relate to lower cranial nerve palsies, causing dysphagia or dysphonia. Neurologic signs may include spasticity, motor and sensory deficits. Neurootologic or neuroophthalmologic findings ranging from nystagmus to impaired visual acuity and papilledema (?) may also be