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CC BY-NC-ND 4.0 · Asian J Neurosurg 2019; 14(02): 598-601
DOI: 10.4103/ajns.AJNS_33_19
Case Report

Resolution of papilledema associated with chiari I malformation with ventriculoperitoneal shunting

Imran Jivraj
1   Department of Neurology and Ophthalmology, Hospital of the University of Pennsylvania, Pennsylvania
,
Grant Liu
1   Department of Neurology and Ophthalmology, Hospital of the University of Pennsylvania, Pennsylvania
,
Nikhil Sharma
2   Department of Neurosurgery, Hospital of the University of Pennsylvania, Pennsylvania
,
Gregory Glauser
2   Department of Neurosurgery, Hospital of the University of Pennsylvania, Pennsylvania
,
Michael Grady
2   Department of Neurosurgery, Hospital of the University of Pennsylvania, Pennsylvania
,
Neil Malhotra
2   Department of Neurosurgery, Hospital of the University of Pennsylvania, Pennsylvania
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Chiari malformation type 1 (CMI) usually presents with cervical pain and suboccipital headache, among other symptoms. Patients with CMI describe symptoms that are clearly correlated with CMI for an average of 3.1 years before diagnosis. We present a case of a patient with bilateral papilledema and CMI but with no long-standing CMI symptoms. She was initially diagnosed with a concussion but developed unremitting intense occipital headaches 4 days later which prompted an evaluation for an alternative diagnosis. Treatment of this case was ventriculoperitoneal shunting, which may serve as an alternative to posterior fossa decompression under certain circumstances.

Key-words:

Chiari I malformation - papilledema - ventriculoperitoneal shunting

Financial support and sponsorship

Nil.




Publication History

Article published online:
09 September 2022

© 2019. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • References

  • 1 Bejjani GK. Definition of the adult Chiari malformation: A brief historical overview. Neurosurg Focus 2001;11:E1.
  • 2 Wilkinson DA, Johnson K, Garton HJ, Muraszko KM, Maher CO. Trends in surgical treatment of Chiari malformation type I in the United States. J Neurosurg Pediatr 2017;19:208-16.
  • 3 Lam S, Auffinger B, Tormenti M, Bonfield C, Greene S. The relationship between obesity and symptomatic Chiari I malformation in the pediatric population. J Pediatr Neurosci 2015;10:321-5.
  • 4 Brodsky MC, Vaphiades M. Magnetic resonance imaging in pseudotumor cerebri. Ophthalmology 1998;105:1686-93.
  • 5 Banik R, Lin D, Miller NR. Prevalence of Chiari I malformation and cerebellar ectopia in patients with pseudotumor cerebri. J Neurol Sci 2006;247:71-5.
  • 6 Vaphiades MS. Resolution of papilloedema after neurosurgical decompression for primary Chiari I malformation. Br J Neurosurg 2003;17:89.
  • 7 Vaphiades MS, Braswell R. Resolution of Chiari I malformation following acetazolamide therapy. Semin Ophthalmol 2007;22:9-11.
  • 8 Thurtell MJ, Wall M. Idiopathic intracranial hypertension (pseudotumor cerebri): Recognition, treatment, and ongoing management. Curr Treat Options Neurol 2013;15:1-2.
  • 9 Vaphiades MS, Eggenberger ER, Miller NR, Frohman L, Krisht A. Resolution of papilledema after neurosurgical decompression for primary Chiari I malformation. Am J Ophthalmol 2002;133:673-8.
  • 10 Rigamonti A, Lauria G, Mantero V, Piamarta F, Parolin M, Salmaggi A, et al. A case of papilloedema associated with Chiari I malformation. J Neurol Sci 2015;353:183-4.
  • 11 Zhang JC, Bakir B, Lee A, Yalamanchili SS. Papilloedema due to Chiari I malformation. BMJ Case Rep 2011;2011. pii: bcr0820114721.
  • 12 Delen F, Togay Işıkay C, Uǧur HÇ. Chiari malformation presenting with pseudotumor cerebri: What is the best treatment? Acta Neurol Belg 2012;112:389-92.
  • 13 Smith V, MacMahon P, Avellino A, Lin J. Commentary: The dilemma of papilledema in Chiari I malformation. Neurosurgery 2018;82:E73-E74.
  • 14 Alnemari A, Mansour TR, Gregory S, Miller WK, Buehler M, Gaudin D, et al. Chiari I malformation with underlying pseudotumor cerebri: Poor symptom relief following posterior decompression surgery. Int J Surg Case Rep 2017;38:136-41.
  • 15 De Tommasi C, Bond AE. Complicated pseudomeningocele repair after Chiari decompression: Case report and review of the literature. World Neurosurg 2016;88:688.e1-7.
  • 16 Lin W, Duan G, Xie J, Shao J, Wang Z, Jiao B, et al. Comparison of results between posterior fossa decompression with and without duraplasty for the surgical treatment of Chiari malformation type I: A systematic review and meta-analysis. World Neurosurg 2018;110:460-74. e5.