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Acute deterioration of a Chiari I malformation: an uncommon neurosurgical emergency

  • Case Report
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Abstract

Objectives

Report and discuss acute neurological deterioration of Chiari I malformation (CMI), surgical treatment and timing, clinical outcome and literature review.

Case report

We report a recent case of a 15-year-old girl admitted for an acute neurological deterioration caused by an undiagnosed hindbrain herniation that required an urgent foramen magnum decompression and external ventricular drainage insertion. Moreover, we report and discuss the literature. To the authors' knowledge, this is only the third paediatric patient identified in this setting to be treated for an acute neurological deterioration due to a previous asymptomatic hindbrain herniation. The patient made an uncomplicated recovery and was discharged home on the seventh postoperative day and has remained well at review.

Discussion

Acute deterioration of CMI in completely asymptomatic patients in absence of concomitant pathological findings is rarely reported in the literature, and exceptional in children.

Conclusions

CMI is typically treated electively, but as this case illustrates, it can present with rapidly deteriorating neurological signs. Symptoms usually respond well to surgical intervention with rapid improvement.

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Authors and Affiliations

  1. Department of Paediatric Neurosurgery, Birmingham Children’s Hospital, Steelhouse Lane, B4 6NH, Birmingham, UK

    Benedetta Ludovica Pettorini & Desiderio Rodrigues

  2. Victoria Eye Unit, Hereford County Hospital, Hereford, UK

    Anna Gao

Authors
  1. Benedetta Ludovica Pettorini
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  2. Anna Gao
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  3. Desiderio Rodrigues
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Correspondence to Benedetta Ludovica Pettorini.

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Pettorini, B.L., Gao, A. & Rodrigues, D. Acute deterioration of a Chiari I malformation: an uncommon neurosurgical emergency. Childs Nerv Syst 27, 857–860 (2011). https://doi.org/10.1007/s00381-011-1442-9

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  • DOI: https://doi.org/10.1007/s00381-011-1442-9

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