Headache, Pain -- and Chiari I Malformation: Test your IQ

Chiari 1 malformation was found to be the cause of this man's year's long history of headache and severe neck pain. Here: a quick quiz on this anomaly.

A 29-year-old man had a several year history of headache and constant, dull, neck pain that radiated up to the posterior scalp and down both shoulders. The headaches and neck pain increased in intensity with coughing, lifting, and exercising. On palpation, there was paraspinal and bony prominence tenderness.

On the visual analog scale, the patient reported a pain level of 6 on a scale of 0 to 10.

No abnormalities were seen on a flexion-extension radiograph of the cervical spine. Cervical MRI scan without contrast revealed a Chiari I malformation with herniation of the cerebellar tonsils measuring up to 2.7 cm (arrow) and extensive syringomyelia (arrowheads).

Which of the following about Chiari I malformation is/are false?

A. It is characterized by herniation of the cerebellar tonsils at least 8 mm below the foramen magnum.
B. The exact cause is unknown, but headaches and neck pain are thought to be caused by irritation of the meninges.
C. Symptoms may be similar to those in patients with obstructive hydrocephalus or cerebellar deficits.
D. A
E. B and C
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