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Do the cerebellar tonsils move during flexion and extension of the neck in patients with Chiari I malformation? A radiological study with clinical implications

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Abstract

Background

In the past, diagnosis of the Chiari I malformation has primarily been made on midsagittal MRI. We hypothesized that based on the frequent presentation of opisthotonos in patients with hindbrain hernia (primarily Chiari II malformation but sometimes Chiari I malformation) that the hyperextension might be a compensatory technique used by such patients to bring the cerebellar tonsils up out of the cervical spine.

Patients and methods

This prospective study reviewed imaging of patients with Chiari I malformation who underwent flexion/extension MRI for evaluation of their hindbrain herniation. Age-matched controls were used for comparison.

Results

In general, there was elevation of the cerebellar tonsils with extension and increased descent with flexion of the cervical spine. In 72 % of patients, flexion of the neck resulted in descent of the cerebellar tonsils. In 64 % of patients, extension of the neck resulted in ascent of the cerebellar tonsils. In the 14 patients with an associated syrinx, 71 % were found to have caudal movement of the cerebellar tonsils with neck flexion, and only 43 % were observed to have any movement of the cerebellar tonsils in neck extension compared to patients without a syrinx where ascent of the tonsils was seen in only nine during neck extension. Two patients were observed to have the reverse finding of ascent of the cerebellar tonsils with neck flexion and descent of the cerebellar tonsils with neck extension. Five patients had no movement of the cerebellar tonsils in either flexion or extension of the neck, and one of these had a small syrinx.

Conclusions

Although minimal and not in all patients, we observed elevation of the herniated cerebellar tonsils with extension of the cervical spine in patients with Chiari I malformation. This finding provides evidence as to why some patients with hindbrain herniation present with opisthotonos and supports earlier findings that CSF flow is reduced at the craniocervical junction in flexion in patients with Chiari I malformation.

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Authors and Affiliations

  1. Seattle Science Foundation, Seattle, WA, USA

    R. Shane Tubbs & Christina M. Kirkpatrick

  2. Neurological Surgery, Penn State Hershey Medical Center, Hershey, PA, USA

    Elias Rizk

  3. Pediatric Neurosurgery Associates, Children’s Healthcare of Atlanta, Atlanta, GA, USA

    Joshua J. Chern

  4. Swedish Neuroscience Institute, Seattle, WA, USA

    Rod J. Oskouian

  5. Pediatric Neurosurgery, Children’s of Alabama, Birmingham, AL, USA

    W. Jerry Oakes

Authors
  1. R. Shane Tubbs
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  2. Christina M. Kirkpatrick
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  3. Elias Rizk
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  4. Joshua J. Chern
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  5. Rod J. Oskouian
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  6. W. Jerry Oakes
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Corresponding author

Correspondence to R. Shane Tubbs.

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Tubbs, R.S., Kirkpatrick, C.M., Rizk, E. et al. Do the cerebellar tonsils move during flexion and extension of the neck in patients with Chiari I malformation? A radiological study with clinical implications. Childs Nerv Syst 32, 527–530 (2016). https://doi.org/10.1007/s00381-016-3014-5

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  • DOI: https://doi.org/10.1007/s00381-016-3014-5

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