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Pediatric Chiari I malformations: do clinical and radiologic features correlate?
1Department of Neurology, University of California at San Francisco, 94143-0114, USA.
Insights
Pediatric Chiari I malformation presents similarly to adults, with headache and neck pain being common. Greater tonsillar ectopia on MRI indicates a higher likelihood of symptoms in children.
Area of Science:
- Neurology
- Pediatric Neurosurgery
- Radiology
Background:
- Chiari I malformation is increasingly recognized in pediatric populations.
- Understanding its clinical presentation in children is limited.
Purpose of the Study:
- To evaluate the relationship between clinical and MRI features of pediatric Chiari I malformations.
- To correlate tonsillar ectopia with clinical presentation and neurological severity.
Main Methods:
- Retrospective chart review and MRI analysis of 49 children with Chiari I malformation.
- Comparison of tonsillar ectopia degree with age at onset, syringomyelia, and neurological severity score.
Main Results:
- Symptoms ranged from 10 months to 14 years, with 57% asymptomatic.
- Headache and neck pain were most frequent; 14% had syringomyelia, 50% had skull base abnormalities.
- Magnitude of tonsillar ectopia (5-23 mm) correlated with severity score (p=0.04).
Conclusions:
- Clinical symptoms of pediatric Chiari I malformation mirror adult presentations.
- Increased tonsillar ectopia on MRI is associated with a higher likelihood of symptomatic presentation in children.
Background:
Although Chiari I malformation is increasingly recognized in children, little is known about its clinical presentation in this age group.
Objective:
To evaluate the relationship between clinical and MRI features of pediatric Chiari I malformations.
Methods:
We performed a chart review and MRI analysis of 49 children with Chiari I malformation. The degree of tonsillar ectopia was compared with age at onset, presence of syringomyelia, and a neurologic severity score as follows: asymptomatic = 0, symptomatic with normal neurologic examination = 1, and symptomatic with abnormal examination = 2.
Results:
Age at onset of symptoms ranged from 10 months to 14 years. Fifty-seven percent of patients were asymptomatic. Headache and neck pain were the most frequent complaints. Syringomyelia was detected in 14% of patients and skull base abnormalities in 50%. The magnitude of tonsillar ectopia (5 to 23 mm) correlated with severity score (p = 0.04) but not with other clinical measures.
Conclusions:
The clinical symptoms of Chiari I malformations in children are nearly identical to those seen in adults. Children with greater amounts of tonsillar ectopia on MRI are more likely to be symptomatic.