Symptomatic Chiari Malformation with Syringomyelia after Cervical Trauma: Case Report

Abstract

Chiari malformation type-I (CM-I) is a congenital disorder characterized by downward displacement of the cerebellar tonsils thru the foramen magnum, with/ without syringomyelia. The patients can be asymptomatic until an aggravation condition like cervical trauma occurs. We present a 54 years old male patient suffering from neck pain after traffic accident. He had mild motor weakness in upper extremities. His neuroradiological examinations revealed C6-7 facet and C7 lamina fractures; syringomyelia descending from C1 to T3 and a CM-I. In early post-traumatic follow-up period, his weakness was progressed, foramen magnum decompression and posterior cervical stabilization was performed. His motor weakness recovered and follow-up magnetic resonance imaging (MRI) examination showed an evident regression of syrinx diameter. It should be kept in mind that previously asymptomatic CM-1 patients can become symptomatic after cervical trauma.

Keywords

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Servikal Travma Sonrası Belirti Veren Chiari Malformasyonu: Olgu Sunumu

Öz

Chiari Malformasyonu Tip I (CM-I), serebellar tonsillerin foramen magnumdan fıtıklaşması ve genlde sirengomyelinin eşlik ettiği konjenital hastalıktır. Servikal travma gibi tetikleyen bir durum olmadığı sürece belirti vermeyebilir. Trafik kazası sonrası boyun ağrısından şikayet eden bir 54 yaşında erkek hasta sunuldu. Üst ekstremitelerinde hafif parezisi vardı. Nöroradyolojik incelemelerinde C6-7 faset ve C7 lamina fraktürü; C1 seviyesinden T3 seviyesine kadar uzanan sirengomyelik kavite ve CM-1 tespit edildi. Travma sonrası erken dönemde parezisi artan hastaya foramen magnum dekompresyonu ve posterior servikal stabilizasyon uygulandı. Hastanın parezisinin gerilediği ve izlem manyetik rezonans incelemelerinde sirenks çapında küçülme olduğu tespit edildi. Belirti vermeyen CM-1 hastalarının travma sonrası belirti verebileceği akılda tutulmalıdır.

Anahtar Kelimeler

• Asemptomatik, servikal, travma, Chiari Malformasyonu tip-I

Kaynakça

1. 1. Barry A, Patten BM, Stewart BH. Possible factors in the development of the Arnold-Chiari malformation. J Neurosurg 1957; 14: 285-301.
2. 2. Chumas PD, Armstrong DC, Drake JM, et al. Tonsillar herniation: the rule rather than the exception after lumboperitoneal shunting in the pediatric population. J Neurosurg 1993; 78: 568-573.
3. 3. Edgar R, Quail P. Progressive post-traumatic cystic and non-cystic myelopathy. Br J Neurosurg 1994; 8: 7-22.
4. 4. Klekamp J, Batzdorf U, Samii M, et al. The surgical treatment of Chiari I malformation. Acta Neurochir (Wien) 1996; 138: 788-801.
5. 5. Koyanagi I, Houkin K. Pathogenesis of syringomyelia associated with Chiari type 1 malformation: review of evidences and proposal of a new hypothesis. Neurosurg Rev. 2010; 33: 271-284.
6. 6. Milhorat TH, Chou MW, Trinidad EM, et al. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery 1999; 44: 1005-1017.
7. 7. Milhorat TH, Capocelli AL Jr, Anzil AP, et al. Milhorat RH. Pathological basis of spinal cord cavitation in syringomyelia: analysis of 105 autopsy cases. J Neurosurg 1995; 82: 802-812.
8. 8. Milhorat TH. Classification of syringomyelia. Neurosurg Focus 2000; 8: E1.

9. 9. Milhorat TH, Johnson RW, Milhorat RH, et al. Clinicopathological correlations in syringomyelia using axial magnetic resonance imaging. Neurosurgery 1995; 37: 206-213.
10. 10. Oldfield EH, Muraszko K, Shawker TH, et al. Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg 1994; 80: 3-15.