Sudden onset of (symptoms of) Chiari malformation after mild trauma

Spina A, Boari N, Gagliardi F, Donofrio CA, Mortini P. Sudden onset of Chiari
malformation type 1 in a young child after trauma. Childs Nerv Syst. 2015 May 10.
[Epub ahead of print]

Abstract
INTRODUCTION:
Chiari 1 malformation is a rare craniovertebral junction malformation accounting up to 1 case in every 1000 newborns per year. It is characterized by herniation of cerebellar tonsils below the foramen magnum sometimes with syringomyelia. Usually, patients have a long history of slowly progressive neurological symptoms. Uncommonly, Chiari 1 malformation could present with a sudden onset, also after trauma. Few cases are reported about young children.
METHODS:
The authors report a case of a 6-month child with symptoms at onset after a mild trauma. The pertinent literature is reviewed.
CONCLUSIONS:
Symptoms of Chiari 1 malformation are usually slowly progressive. Few cases have been reported of the sudden onset of symptoms, some of these after trauma. In young children, the clinical setting could be insidious and potentially lethal. A sudden onset of Chiari 1 malformation must be considered as a consequence of trauma, usually after performing a brain MRI. Management of these cases is still controversial, and surgery may be indicated in managing symptoms; however, it seems to not affect clinical outcome.