Reversible hydromyelia in Chiari malformation

Case contributed by Dr Varun Babu

Presentation

Initial presentation - dorsal back ache, non radiating.

Patient Data

Age: 35 years
Gender: Female
MRI

Brain (at presentation)

  • normal development of supratentorial neuroparenchyma.
  • well developed posterior fossa.
  • both cerebellar hemispheres as well as vermis are well formed. 
  • tonsillar herniation and cervicomedullary impingement. 
  • unremarkable upper cervical cord. 
MRI

2 years later

  • patient presented again with symptoms of quadriparesis. 
  • cervical cord C5 to C7 level segmental central canal widening suggestive of rising cervical cord CSF pressure due to cervicomedullary compression. 
MRI

1st month post surgery

  • appreciable relief in the hydromyelia with post operative changes seen in the occipital bone. 
MRI

9 months post surgery

  • complete resolution of cervical cord hydromyelia. 

Case Discussion

The beauty of the ability of the human body to naturally find alternative ways to combat stress is depicted here wherein there is distension of a central canal that becomes redundant after development. The relief in the pressure at the cervicomedullary junction coupled with free CSF flow enabled the restoration of normal function of the CSF system and thereby disappearance of the hydromyelia.   

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Case information

rID: 48624
Case created: 17th Oct 2016
Last edited: 17th Oct 2016
Inclusion in quiz mode: Included

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