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Case #1 SYB

Case #1 SYB. Irene Woo. LU is a 7 yo male presents for follow up MRI for altered mental status, dementia, psychiatric disorder, headaches PMH: 22wk found to have abnormal increase in head circumference and increased size of ventricles on ultrasound. Also increased drooling.

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Case #1 SYB

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  1. Case #1 SYB Irene Woo

  2. LU is a 7 yo male presents for follow up MRI for altered mental status, dementia, psychiatric disorder, headaches • PMH: 22wk found to have abnormal increase in head circumference and increased size of ventricles on ultrasound. Also increased drooling.

  3. T2 MRI of the Brain

  4. Findings on Brain MRI of L.U • Pointing of the cerebellar tonsils with displacement of the tonsils 6mm below the foramen magnum. • Decreased amount of subarachnoid space in the foramen magnum consistent with crowding from downward displacement of the cerebellar tonsils. • Brain parenchyma is normal • Extra-axial fluid spaces and ventricles are normal in size and configuration • No evidence of mass lesion, hemorrhage, or acute ischemia

  5. Chiari Malformation • Type 1 (adult) • Type 2 (pediatric) associated with myelomeningocele • Type 3 associated with encephalocele (portion of cerebellum or brainstem extends through an abnormal opening in the back of the skull) • Type 4 cerebellarhypoplasia

  6. Symptoms • Headache • Neck pain (running down the shoulders at times) • Unsteady gait (problems with balance) • Poor hand coordination (fine motor skills) • Numbness and tingling of the hands and feet • Dizziness • Difficulty swallowing (sometimes accompanied by gagging, choking and vomiting) • Vision problems (blurred or double vision) • Slurred speech

  7. Complications • Hydrocephalus • Spina bifida • Syringomyelia • Tethered cord syndrome • Spinal curvature

  8. T2 MRI of Cervical Spine

  9. Treatment • Posterior fossacraniectomy or posterior fossa decompression

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