Transcript Slide 1

Case #1 SYB
Irene Woo
 LU is a 7 yo male presents for follow up MRI for altered
mental status, dementia, psychiatric disorder, headaches
 PMH: 22wk found to have abnormal increase in head
circumference and increased size of ventricles on ultrasound.
Also increased drooling.
T2 MRI of the Brain
Findings on Brain MRI of L.U
 Pointing of the cerebellar tonsils with displacement of the
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tonsils 6mm below the foramen magnum.
Decreased amount of subarachnoid space in the foramen
magnum consistent with crowding from downward
displacement of the cerebellar tonsils.
Brain parenchyma is normal
Extra-axial fluid spaces and ventricles are normal in size and
configuration
No evidence of mass lesion, hemorrhage, or acute ischemia
Chiari Malformation
 Type 1 (adult)
 Type 2 (pediatric) associated with myelomeningocele
 Type 3 associated with encephalocele (portion of cerebellum
or brainstem extends through an abnormal opening in the
back of the skull)
 Type 4 cerebellar hypoplasia
Symptoms
 Headache
 Neck pain (running down the shoulders at times)
 Unsteady gait (problems with balance)
 Poor hand coordination (fine motor skills)
 Numbness and tingling of the hands and feet
 Dizziness
 Difficulty swallowing (sometimes accompanied by gagging,
choking and vomiting)
 Vision problems (blurred or double vision)
 Slurred speech
Complications
 Hydrocephalus
 Spina bifida
 Syringomyelia
 Tethered cord syndrome
 Spinal curvature
T2 MRI of Cervical Spine
Treatment
 Posterior fossa craniectomy or posterior fossa decompression