Friday, March 21, 2008


Most cases of this are discovered in infants and children with stridor and swallowing difficulties. But this MRI is of a woman in her forties with headache. You notice her gait is somewhat clumsy, there is diminished upward gaze, truncal instability, and bilateral increased reflexes.

Challenge: What's the diagnosis?

This image and case are from a website, shown under Fair Use. This is because I couldn't find a great UpToDate article.


Craig said...


This is Arnold-Chiari malformation which leads to cerebellar tonsillar herniation. The T1-weighted MRI on the left showed enlargement of the lateral ventricles with effacement of cortical sulci. The T1-weighted MRI on the right shows inferior displacement of the cerebellar tonsils. Benedict Arnold, of course, was a traitor in the American Revolution.


Alex said...

clumsy gait? not a dandy walker! said...

Dandy-Walker? Naw. Cerebellum looks pretty not-absent. Looks like moar herniation, like Craig sez.