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Arnold-Chiari malformation with syringomyelia in an elderly woman
C Geroldi1, G B Frisoni, A Bianchetti
1Alzheimer's Unit, IRCCS S. Giovanni di Dio, Sacro Cuore Fatebenefratelli Hospital, Brescia, Italy.
Presentation:
A 76-year-old woman, complaining of leg pain and unsteady gait for 3 years, presented with a spastic paraparetic gait, severe spasticity and touch, thermal and pain sensory loss limited to arms, lower thorax and upper abdomen. Brain and spinal cord magnetic resonance imaging showed a large loculated syrinx. Cerebellar tonsillar herniation into the foramen magnum was also seen (Arnold-Chiari malformation, type I).
Outcome:
The patient had successful cervico-spinal surgical decompression which resulted in marked reduction in hypertonia and weakness, normal gait and normal joint movement at 6 months.
Conclusion:
This unusual, late clinical presentation of a congenital disease underlines the importance of a comprehensive diagnostic work-up in the elderly patients with complex neurological signs.