Skip to main content

Advertisement

SpringerLink
Log in

Chiari malformation type 1 presenting as isolated unilateral foot drop with rapid recovery following posterior fossa decompression

  • Case Report
  • Published:
Child's Nervous System Aims and scope Submit manuscript

Abstract

Background

Chiari malformation (CM) type 1 is characterized by descent of the cerebellar tonsils resulting from crowding of the posterior fossa. In 30% of cases, it is associated with syringomyelia. When symptomatic, it may result in a classic constellation of symptoms.

Case Presentation

Here we describe a case of a 16-year-old male who presented with isolated, unilateral foot drop due to CM type 1 and holosyrinx. This unique presentation is extremely rare, and we additionally present a review of all other reported cases in the literature. After undergoing posterior fossa decompression with C1 laminectomy and duraplasty, our patient made a complete neurological recovery within 2 weeks postoperatively and his MRI entire spine at 3 months postoperatively demonstrated a nearly complete resolution of the holosyrinx with significant decompression of the foramen magnum.

Conclusion

This rare presentation highlights the importance of maintaining a broad differential, particularly in pediatric patients, and expediting the workup in order to offer a surgical decompression within 1–2 months of foot weakness to maximize the probability of a full neurological recovery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. Ciaramitaro P, Ferraris M, Massaro F, Garbossa D (2019) Clinical diagnosis-part I: what is really caused by Chiari I. Childs Nerv Syst 35(10):1673–1679

    Article  Google Scholar 

  2. Carey M, Fuell W, Harkey T, Albert GW (2020) Natural history of Chiari I malformation in children: a retrospective analysis. Childs Nerv Syst

  3. Davidson L, Phan TN, Myseros JS (2020) Long-term outcomes for children with an incidentally discovered Chiari malformation type 1: what is the clinical significance? Childs Nerv Syst

  4. Ene CI, Wang AC, Collins KL (2020) Expansile duraplasty and obex exploration compared with bone-only decompression for Chiari malformation type I in children: retrospective review of outcomes and complications. J Neurosurg Pediatr 1–8

  5. Henderson D, Alix JJP, Sinha S (2019) Holocord syrinx presenting with foot drop. J Surg Case Rep 2019(4):rjz082

  6. Panda AK, Kaur M (2013) Rapidly progressive foot drop: an uncommon and underappreciated cause of Chiari I malformation and holocord syrinx. BMJ Case Rep

  7. McMillan HJ, Sell E, Nzau M, Ventureyra EC (2011) Chiari 1 malformation and holocord syringomyelia presenting as abrupt onset foot drop. Childs Nerv Syst 27(1):183–186

    Article  Google Scholar 

  8. Laufer I, Engel M, Feldstein N, Souweidane MM (2008) Chiari malformation presenting as a focal motor deficit. Report of two cases. J Neurosurg Pediatr 1(5):392–5

  9. Muhn N, Baker SK, Hollenberg RD, Meaney BF, Tarnopolsky MA (2002) Syringomyelia presenting as rapidly progressive foot drop. J Clin Neuromuscul Dis 3(3):133–134

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Neurological Surgery, Northwestern University, Chicago, IL, USA

    Constantine L. Karras, Nikhil K. Murthy, Siting J. Trybula & Tord D. Alden

  2. Division of Pediatric Neurosurgery, Ann & Robert H. Lurie Children’s Hospital of Chicago, 225 E. Chicago Avenue, Chicago, IL, USA

    Tord D. Alden

Authors
  1. Constantine L. Karras
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Nikhil K. Murthy
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Siting J. Trybula
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tord D. Alden
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Tord D. Alden.

Ethics declarations

Conflict of interest

All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest (such as honoraria; educational grants; participation in speakers’ bureaus; membership, employment, consultancies, stock ownership, or other equity interest; and expert testimony or patent-licensing arrangements) in the subject matter or materials discussed in this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Karras, C.L., Murthy, N.K., Trybula, S.J. et al. Chiari malformation type 1 presenting as isolated unilateral foot drop with rapid recovery following posterior fossa decompression. Childs Nerv Syst 38, 821–825 (2022). https://doi.org/10.1007/s00381-021-05275-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00381-021-05275-9

Keywords

Search

Navigation