Management of Arnold-Chiari Malformation; After long Period Headaches, Syncope and Trauma: A Report of 3 Cases

Abstract

Chiari malformation type 1 (CM1) is a condition in which the cerebellar tonsils move downward into the spinal canal, affecting the area where the skull meets the neck. When there are signs of a tonsillar obstruction or herniation >5–14 mm, which happens when the tonsillar structures go through the posterior cranial fossa, symptoms start to show up.  We report a case of a 65-year-old woman with headache, dizziness, and sensory disturbances in the extremities. Therefore, diagnostic imaging was recommended: MRI revealed a Chiari type I malformation (CM1) with tonsillar descent >5 mm, syringomyelia from C2 to T4, and the presence of syringomyelia. In the second case, we present a 56-year-old woman with persistent headache, neck pain, and dizziness, so diagnostic imaging was recommended: MRI revealed a decrease in the tonsils through the foramen magnum, confirming Chiari type 1 malformation with the presence of syringomyelia in the spinal cavity. In the third case, a 49-year-old woman presented with a history of dizziness, falls, and sensory disturbances. She had experienced worsening symptoms for five years, culminating in a recent fall due to syncope and trauma. Imaging and diagnosis: Magnetic resonance imaging showed that she has Chiari malformation (CM1) with a 6-mm drop in the cerebellar tonsils and signs of increased pressure inside the skull. The diagnoses was confirmed by the presence of syringomyelia in the spinal cavity. These cases demonstrate that CM1 can escalate to a surgical emergency, necessitating timely imaging diagnostics, including MRI or CT scans, to confirm the diagnosis and determine the appropriate surgical course. to enlarge the posterior cranial fossa through laminectomy, thereby alleviating neural compression.