CONVERSION TO SYMPTOMATIC CHIARI I MALFORMATION AFTER MINOR HEAD OR NECK TRAUMA

Wan, Michael J. B.Sc.; Nomura, Hiroshi M.D., Ph.D.; Tator, Charles H. M.D., Ph.D.

doi: 10.1227/01.NEU.0000325498.04975.C0
Clinical Studies

OBJECTIVE: The Chiari I malformation is a rare disorder characterized by downward herniation of the brainstem and cerebellar tonsils through the foramen magnum. Many individuals with the Chiari I malformation do not become symptomatic until adulthood, and the factors that contribute to the onset of symptoms have not been well characterized. The purpose of this systematic chart review was to determine the incidence and validity of minor head or neck trauma as precipitating factors for the onset of symptomatic Chiari I malformation.

METHODS: The charts of all patients seen by the senior author (CHT) between January 1985 and July 2006 were reviewed to identify patients who had presented with symptomatic Chiari I malformation after minor head or neck trauma. Specific inclusion criteria were used to determine whether the onset of symptoms could be reliably attributed to the minor trauma.

RESULTS: Of the 85 patients with symptomatic Chiari I malformation seen by the senior author during this time, 11 (12.9%) had a history of minor head or neck trauma preceding the onset of symptoms. Of these, there were 3 patients (3.5%) in whom the onset of symptoms could be attributed to the trauma based on strict inclusion criteria.

CONCLUSION: Minor head or neck trauma can precipitate the onset of symptoms in a small number of previously asymptomatic patients with Chiari I malformation. Health care professionals must be aware that neurological symptoms that persist or worsen after minor head or neck trauma could indicate an underlying Chiari I malformation.

Toronto Western Research Institute, Toronto Western Hospital, Toronto, Canada (Wan) (Nomura)

Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Toronto, Canada (Tator)

Reprint requests: Charles H. Tator, M.D., Ph.D., Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto Western Hospital, Room 4W-433, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada. Email: charlestator@uhn.ca

Received, December 11, 2007.

Accepted, June 4, 2008.

Copyright © by the Congress of Neurological Surgeons