Adult Chiari malformation with headache and trigeminal dysesthesia

Arriving at a correct diagnosis in some cases of facial pain and headache can test the time, patience, and diagnostic skills of any clinician. When the symptoms are diffuse with few localizing signs, it is easy to attribute pain to a functional origin. The case described underlines the importance of careful clinical examination and the use of magnetic resonance imaging, which proved the only positive diagnostic aid in this instance. The value of magnetic resonance imaging in redefining Chiari malformations is discussed and the question of appropriate interpretation of findings aired.