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 www.urmc.rochester.edu website, shown under Fair Use. This is because I couldn't find a great UpToDate article.
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3 comments:
Benedict
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.
Source: www.urmc.rochester.edu.
clumsy gait? not a dandy walker!
Dandy-Walker? Naw. Cerebellum looks pretty not-absent. Looks like moar herniation, like Craig sez.
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