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Case Studies is a
feature designed to highlight interesting patient cases reported in the
research. Given the lack of knowledge about CM/SM, much of the
published research comes in the form of case studies - doctors describing
one or two patients they have seen and treated - as opposed to rigorous
scientific studies. While this type of publication doesn't advance the
scientific cause as much, it does give us a window into some of the issues
surrounding CM/SM, including lasting side effects and related conditions.
And hopefully, some of our readers will say, "Hey, that's just like me!" and
know they are not alone in what they are going through.
November 15, 2005 --
Spontaneous Resolution Of Isolated Chiari I Malformation
Authors: N.S. Jatavallabhula, et. al.
University/Hospital: Birmingham Children's Hospital, United Kingdom
Journal: Child's Nervous System 2005 Aug 31; Online
Introduction: It's every Chiari parent's dream, Chiari goes away on
its own. But the question is, if a Chiari malformation resolves on its
own, was it ever really Chiari?
Patient: A 14 month boy with a history of kidney failure was
taken to the ER because of jerky movements of his entire body. Tests
for seizures were normal as was an EEG. No action was taken at that
time. The boy was seen again 2 months later because of the same
movements. MRI revealed a 5mm Chiari malformation, but doctors were
not sure the movements were related to it and decided to just observe.
His kidney problems continued to worsen and he eventually needed a
transplant. When he was 6 six years old, he was taken to the ER again
because of headaches, dizziness, and vomiting. MRI showed complete
resolution of the Chiari malformation.
Treatment: No Chiari related treatment was ever given.
Outcome: The herniated tonsils moved back up into the normal
position.
Author's Discussion: The authors point out that only a few
cases like this have been reported in the literature, so they are quite
rare. One theory is that as children grow there is a mismatch between
how quickly the skull and the brain grow. For a period of time, the
skull may be too small to accommodate the cerebellum, but once it catches
up, the cerebellum is able to move up into its natural position.
Editor's Discussion: This case highlights how incomplete the
current definition of Chiari is. Study after study has shown little or
no correlation between the amount of herniation and symptoms or clinical
outcome. It also demonstrates that MRI's are a necessary, but not
sufficient part of diagnosing Chiari. An MRI alone does not always
show the whole picture.
--Rick Labuda
Back to Table of Contents |
cerebellar tonsils - portion of the cerebellum located at the bottom,
so named because of their shape
cerebellum - part of the brain located at the bottom of the skull,
near the opening to the spinal area; important for muscle control, movement,
and balance
cerebrospinal fluid (CSF) - clear liquid which surrounds, and
protects, the brain and spinal cord Chiari malformation -
condition where the cerebellar tonsils are displaced out of the skull
area into the spinal area, causing compression of brain tissue and
disruption of CSF flow
decompression surgery - common term for any of several variations of a
surgical procedure to alleviate a Chiari malformation
laminectomy - surgical removal of part (the bony arch) of one or more
vertebrae
magnetic resonance imaging (MRI) - diagnostic test which uses a large
magnet to create images of internal body parts
renal - having to do with the kidneys |