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1. J Neurosurg
1995 Sep;83(3):556-558 Acquired Chiari I malformation and syringomyelia
associated with bilateral chronic subdural hematoma. Case
report.Morioka T, Shono T, Nishio S, Yoshida K, Hasuo K, Fukui M
Department of Neurosurgery, Kyushu University, Fukuoka, Japan.
The authors report a case of bilateral
chronic subdural hematoma in a 25-year-old woman who had occipital and neck
pain. Magnetic resonance imaging revealed progressive caudal descent of the
cerebellar tonsils (acquired Chiari I malformation) and a large eccentric syrinx
in the spinal cord from the C3-T7 levels. Spontaneous disappearance of the
chronic subdural hematomas resulted in radiographic resolution of both lesions,
as well as clinical improvement. Theories of syringomyelia formation, the
relationship to acquired Chiari I malformation, and the implications of this
case are discussed.
2. J
Neurosurg 1998 Feb;88(2):237-242
Acquired Chiari I malformation secondary to spontaneous spinal cerebrospinal
fluid leakage and chronic intracranial hypotension syndrome in seven cases.
Atkinson JL, Weinshenker BG, Miller GM, Piepgras DG, Mokri B
Department of Neurological Surgery, Mayo
Clinic, Rochester, Minnesota 55905,
OBJECT: Spontaneous spinal cerebrospinal
fluid (CSF) leakage with development of the intracranial hypotension syndrome
and acquired Chiari I malformation due to lumbar spinal CSF diversion procedures
have both been well described. However, concomitant presentation of both
syndromes has rarely been reported. The object of this paper is to present data
in seven cases in which both syndromes were present. Three illustrative cases
are reported in detail. METHODS: The authors describe seven symptomatic cases of
spontaneous spinal CSF leakage with chronic intracranial hypotension syndrome in
which magnetic resonance (MR) images depicted dural enhancement, brain sagging,
loss of CSF cisterns, and acquired Chiari I malformation. CONCLUSIONS: This
subtype of intracranial hypotension syndrome probably results from chronic
spinal drainage of CSF or high-flow CSF shunting and subsequent loss of brain
buoyancy that results in brain settling and herniation of hindbrain structures
through the foramen magnum. Of 35 cases of spontaneous spinal CSF leakage
identified in the authors' practice over the last decade, MR imaging evidence of
acquired Chiari I malformation has been shown in seven. Not to be confused with
idiopathic Chiari I malformation, ideal therapy requires recognition of the
syndrome and treatment directed to the site of the spinal CSF leak. PMID:
9452230, UI: 98112609
3.
Pediatr Neurosurg 1995;22(5):251-254
Acquired Chiari-I malformation and hydromyelia secondary to a giant
craniopharyngioma.
Lee M, Rezai AR, Wisoff JH
Division of Pediatric Neurosurgery, New York University Medical Center, NY 10016
Hydromyelia, or
hydrosyringomyelia is frequently associated with the Chiari I malformation of
the cerebellar tonsils. Descent of the cerebellar tonsils is considered a
congenital anomaly with a few reports of 'acquired' Chiari I malformation. We
report a patient with a giant craniopharyngioma and hydrocephalus who at
presentation had a concomitant Chiari I malformation and hydromyelia. The
patient underwent gross total resection of the tumor and, with no further
treatment, demonstrated spontaneous resolution of the Chiari I malformation and
hydromyelia during the postoperative period. This suggests that the Chiari I
malformation and the resulting hydromyelia were 'acquired', and were caused by
an intracranial mass effect. This provides further evidence for an associative
mechanism of cerebellar tonsillar descent and the development of hydromyelia.
PMID: 7547457, UI: 96018158
4.
"Acquired" Chiari I malformation. Case report.
Huang PP, Constantini S
Department of Neurosurgery, New York University Medical Center, New York.
Tonsillar descent of the cerebellum in Chiari
I malformations is often considered a congenital defect. A patient is presented
in whom magnetic resonance (MR) imaging revealed normally positioned cerebellar
tonsils; however, 1 year later MR imaging was repeated for evaluation of gait
abnormalities and showed descent of the cerebellar tonsils. This case
illustrates worsening symptoms with progressive descent of the cerebellar
tonsils and suggests that Chiari I malformations can evolve postnatally. Note:
One would then reason that ACM is not necessarily congental i.e. is not always
pre-existing:
5. Acta
Neurochir (Wien) 1998;140(5):417-27; discussion 427-8
The acquired Chiari malformation and
syringomyelia following spinal CSF drainage: a study of incidence and
management.
Johnston I, Jacobson E, Besser M
Department of Neurosurgery, New Children's Hospital, Australia.
Firstly, 14 patients are described who
developed either an acquired Chiari malformation (ACM) alone (7 cases) or ACM
and syringomyelia (7 cases) after lumbar subarachnoid space (SAS) shunting or in
one case, epidural anaesthesia with SAS penetration. Four groups are considered:
3 cases with craniofacial dysostosis and communicating hydrocephalus (CH), 4
cases with CH alone, 3 cases with pseudotumour cerebri (PTC) and a miscellaneous
group (4 cases). Initial treatment was varied: resiting the shunt to ventricle
or cisterna magna [6], adding an H-V valve [1], syrinx shunting [4] and
posterior fossa decompression [3]. Further treatment was required in 6 cases.
Secondly, incidence was examined in 87 patients with PTC initially treated
either by lumbar SAS shunting [70] or cisterna magna shunting [17]. In the first
sub-group, 11 cases (15.7 per cent) developed an ACM, 3 symptomatic (as above)
and eight asymptomatic with 1 case also having syringomyelia whereas 1 case
occurred in the second group with a questionanably symptomatic ACM. While
accurate for symptomatic lesions, these figures are tentative with respect to
asymptomatic lesions due to inadequate pre-treatment radiology and detailed MR
follow-up. The main conclusions are, first, that the incidence of symptomatic
ACM and/or syringomyelia is not high enough to warrant abandoning SAS shunting;
second that asymptomatic lesions need not necessarily be treated and third, that
when treatment is required, shunt resiting is the first choice.
PMID: 9728240, UI: 98397486
A Case of a Temporary ACM/
Syrinx
28
yr old female with a car accident head injury- when the injury healed the
ACM/syrinx almost disappeared
Source- W.C. Clivero and D.H. Dinh,
Neurology, v. 30, #5, 758 (1992)
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