Pearls Chiari malformation

1.80 percent of patients with cough headache have cm type 1 although only a minority of patients with cm 1 have cough headache. The degree of tonsillar herniation does not correlate

2.  Cm1 presents most often from ages 8 to 9 and from 31 to 46

3.  Spinal cord syndrome occurs in 65 to 84 percent and includes weakness and sensory changes.

4. Brain stem syndrome occurs in 22 to 38 percent and includes blurred vision, horizontal or downbeating nystagmus, and diplopia (upper) or hoarseness , dysphonia, dysarthria, dysphasia, vocal cord paralysis, palatal weakness and tongue atrophy ( lower).

5. Cerebella symptoms occur in 11 percent with dyscoordination, ataxia and dysmetria

6.  Cortical symptom is rare 3 percent with brain fog, depression, generalized weakness and fatigue

7.  Even more rare systemic syndrome , two percent, have chest pain, sob, postural hypotension and syncope

8 presenting symptoms include 82 to 90 percent have suboccipital headache, 78 to 81 percent have posterior neck pain, 60 to 67 have dizziness, 49 percent have nausea.

Others with percent

Weakness. 69

Numbness 56

Altered temperature sensation 52

Unsteady 40

Double vision 13

Swallowing trouble 8

Tinnitus. 7

Dysarthria 3

Dizzy.       3

Hiccups. 1

9.  Ciné mri phase contrast may show elevated high velocity jets upwards and other abnormalities of normal bidirectional csf flow. Technique also can be used to follow cm1. Technique is especially useful to differentiate headaches of cm1 v other causes