Pyramidal and Proprioceptive Dysfunctions as the Main Neurologic Features in Symptomatic Type I Chiari Malformation Patients

Introduction: Broader access to Magnetic Resonance Imaging (MRI) has increased the diagnosis of tonsillar ectopia with most of these patients being asymptomatic. Early diagnosis and treatment of type I Chiari Malformation (CM I) patients have impact on the prognosis.

Objective: Supplements information about the neurologic exam of symptomatic patients with CM.

Methods: The sample was composed of 32 symptomatic patients with CM I diagnosed by tonsils more than 5 mm below the magnum foramen (defined by sagittal T2 MRI) and at least one of the following alterations: intractable occipital headache, ataxia, upper or lower motor neuron impairment, sensitivity deficits (superficial and deep) or lower cranial nerves disorders.

Results: Occipital headache was the most frequent symptom (53.12%). During the physical exam the most common dysfunctions were from pyramidal system (96.87%) followed by posterior cord syndrome (87.5%). In this study, patients became symptomatic around the fifth decade of life. Occipital headache, symptoms in the upper limbs, gait and proprioceptive disorders were common findings.

Conclusion: Deep tendinous reflexes and proprioception disorders were the main neurologic features in symptomatic CM I patients.