Journal of Pediatric Neurology 2021; 19(06): 414-418
DOI: 10.1055/s-0040-1718378
Case Report

Movement Disorder as Unusual Manifestation of Chiari Malformation Type II in a Newborn

1   Department of Neurosurgery, Niguarda Ca'Granda Hospital, Milan, Italy
2   Department of Human Neurosciences, Neurosurgery, Policlinico Umberto I, Sapienza University of Rome, Rome, Italy
,
Roberto Mai
3   Department of Neurology, Niguarda Ca'Granda Hospital, Milan, Italy
,
Marco Cenzato
1   Department of Neurosurgery, Niguarda Ca'Granda Hospital, Milan, Italy
,
Giuseppe D'Aliberti
1   Department of Neurosurgery, Niguarda Ca'Granda Hospital, Milan, Italy
,
Giuseppe Talamonti
1   Department of Neurosurgery, Niguarda Ca'Granda Hospital, Milan, Italy
› Author Affiliations

Abstract

Chiari malformation type II (CM-II) is a hindbrain developmental malformation. Movement disorders are rarely described as associated with this condition. We describe the case of a newborn affected by CM-II presenting with head and neck tremors a few days after myelomeningocele repair surgery. Later, self-resolving episodes of expiratory apneas arose. Cranial ultrasounds showed progressive ventricular dilatation. She underwent ventriculoperitoneal shunt followed by craniocervical bony decompression. After surgery, both apnea and tremors disappeared. This particular presentation of CM-II is very rare and potentially difficult to diagnose.



Publication History

Received: 07 July 2020

Accepted: 21 August 2020

Article published online:
09 October 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 
  • References

  • 1 Chiari H. Concerning alterations in the cerebellum resulting from cerebral hydrocephalus. 1891. Pediatr Neurosci 1987; 13 (01) 3-8
  • 2 Akbari SHA, Limbrick Jr DD, Kim DH. et al. Surgical management of symptomatic Chiari II malformation in infants and children. Childs Nerv Syst 2013; 29 (07) 1143-1154
  • 3 Kim I, Hopson B, Aban I. et al. Decompression for Chiari malformation type II in individuals with myelomeningocele in the National Spina Bifida Patient Registry. J Neurosurg Pediatr 2018; 22 (06) 652-658
  • 4 Messing-Jünger M, Röhrig A. Primary and secondary management of the Chiari II malformation in children with myelomeningocele. Childs Nerv Syst 2013; 29 (09) 1553-1562
  • 5 McDowell MM, Blatt JE, Deibert CP, Zwagerman NT, Tempel ZJ, Greene S. Predictors of mortality in children with myelomeningocele and symptomatic Chiari type II malformation. J Neurosurg Pediatr 2018; 21 (06) 587-596
  • 6 Talamonti G, Marcati E, Mastino L, Meccariello G, Picano M, D'Aliberti G. Surgical management of Chiari malformation type II. Childs Nerv Syst 2020; 36 (08) 1621-1634
  • 7 Alkan Ozdemir S, Ozdemir N, Karadag A, Ilhan O, Ozer E. Surgical decision management in Chiari type 2 malformation: single center experience. J Gynecol Obstetrics Neonatol 2017; 14: 101-107
  • 8 Hashiguchi K, Morioka T, Murakami N. et al. Sequential morphological change of Chiari malformation type II following surgical repair of myelomeningocele. Childs Nerv Syst 2016; 32 (06) 1069-1078
  • 9 Talamonti G, D'Aliberti G, Collice M. Myelomeningocele: long-term neurosurgical treatment and follow-up in 202 patients. J Neurosurg 2007; 107 (05) 368-386
  • 10 Alford EN, Hopson BD, Safyanov F. et al. Care management and contemporary challenges in spina bifida: a practice preference survey of the American Society of Pediatric Neurosurgeons. J Neurosurg Pediatr 2019; 30: 1-10
  • 11 Talamonti G, Zella S. Surgical treatment of CM2 and syringomyelia in a series of 231 myelomeningocele patients. Neurol Sci 2011; 32 (Suppl. 03) S331-S333
  • 12 Cross JH. Differential diagnosis of epileptic seizures in infancy including the neonatal period. Semin Fetal Neonatal Med 2013; 18 (04) 192-195
  • 13 Wolf DS, Singer HS. Pediatric movement disorders: an update. Curr Opin Neurol 2008; 21 (04) 491-496
  • 14 Deuschl G, Bain P, Brin M. Ad Hoc Scientific Committee. Consensus statement of the Movement Disorder Society on Tremor. Mov Disord 1998; 13 (Suppl. 03) 2-23
  • 15 Bhidayasiri R. Differential diagnosis of common tremor syndromes. Postgrad Med J 2005; 81 (962) 756-762
  • 16 Kamble N, Pal PK. Tremor syndromes: a review. Neurol India 2018; 66: S36-S47
  • 17 Gautam P, Sharma N, Chaudhary S, Kaushal A. Infantile tremor syndrome in modern times. J Pediatr Neurosci 2017; 12 (03) 232-236
  • 18 Gupta R, Rawat AK, Singh P, Gupta J, Pathak A. Infantile tremor syndrome: current perspectives. Res Rep Trop Med 2019; 10: 103-108
  • 19 Hess CW, Pullman SL. Tremor: clinical phenomenology and assessment techniques. Tremor Other Hyperkinet Mov (N Y) 2012; 2: tre-02-65-365-1
  • 20 Raina GB, Cersosimo MG, Folgar SS. et al. Holmes tremor: clinical description, lesion localization, and treatment in a series of 29 cases. Neurology 2016; 86 (10) 931-938
  • 21 Gajos A, Bogucki A, Schinwelski M. et al. The clinical and neuroimaging studies in Holmes tremor. Acta Neurol Scand 2010; 122 (05) 360-366
  • 22 Manto M. Cerebellar motor syndrome from children to the elderly. Handb Clin Neurol 2018; 154: 151-166
  • 23 Renne B, Rueckriegel S, Ramachandran S, Radic J, Steinbok P, Singhal A. Bobble-head doll syndrome: report of 2 cases and a review of the literature, with video documentation of the clinical phenomenon. J Neurosurg Pediatr 2018; 21 (03) 236-246
  • 24 de Brito Henriques JG, Henriques KS, Filho GP, Fonseca LF, Cardoso F, Da Silva MC. Bobble-head doll syndrome associated with Dandy-Walker syndrome. Case report. J Neurosurg 2007; 107 (03) 248-250
  • 25 Hottinger-Blanc PMZ, Ziegler AL, Deonna T. A special type of head stereotypies in children with developmental (cerebellar) disorder: description of 8 cases and literature review. Eur J Paediatr Neurol 2002; 6 (03) 143-152
  • 26 Mba SE, Musara A, Kalangu K, Nyamapfene B. An unusual presentation of bobble-head doll syndrome in a patient with hydranencephaly and Chiari 3 malformation. Childs Nerv Syst 2019; 35 (05) 879-882
  • 27 Vanhatalo S, Paetau R, Mustonen K, Hernesniemi J, Riikonen R. Posttraumatic tremor and Arnold Chiari malformation: no sign of compression, but cure after surgical decompression. Mov Disord 2000; 15 (03) 581-583
  • 28 Cammalleri R, D'Amelio M, Gangitano M, Raimondo D, Rossetti M, Camarda R. Monosymptomatic presentation of type I Arnold-Chiari malformation: report of two cases. Ital J Neurol Sci 1994; 15 (01) 57-60
  • 29 Nakae Y, Tamaki H, Maekawa K. Stereotypical lower-limb movements of a child with Arnold-Chiari malformation. Dev Med Child Neurol 1993; 35 (06) 540-543
  • 30 Hoffman HJ, Hendrick EB, Humphreys RP. Manifestations and management of Arnold-Chiari malformation in patients with myelomeningocele. Childs Brain 1975; 1 (04) 255-259
  • 31 Gilbert JN, Jones KL, Rorke LB, Chernoff GF, James HE. Central nervous system anomalies associated with meningomyelocele, hydrocephalus, and the Arnold-Chiari malformation: reappraisal of theories regarding the pathogenesis of posterior neural tube closure defects. Neurosurgery 1986; 18 (05) 559-564
  • 32 Pollack IF, Pang D, Albright AL, Krieger D. Outcome following hindbrain decompression of symptomatic Chiari malformations in children previously treated with myelomeningocele closure and shunts. J Neurosurg 1992; 77 (06) 881-888