Presentation of a Previously Asymptomatic Chiari I Malformation by a Flexion Injury to the Neck

Abstract

Flexion injury and/or whiplash injury to the neck in car accidents are usually trivial injuries with no serious neurological deficits. Our intention was to point out the importance to proceed with diagnostic procedures if neurological deficits do occur in order to reveal the true cause of the deficit. The paper presents the case of a 35-year-old woman who sustained a flexion injury to the neck. A relatively trivial injury to the neck promoted a progressive neurological deterioration. The standard diagnostic procedures (x-ray, computed tomography scan) were normal. Further diagnostics with magnetic resonance imaging was required to reveal an underlying Chiari I malformation. Finally, the operative decompression of the craniocervical junction was performed. Following the surgical treatment, the patient's clinical symptoms regressed. One year after her discharge, she remains in good physical condition. To our knowledge, this case is the first report of the manifestation of Chiari I malformation in the adult as a result of a flexion or whiplash injury of the neck. This unusual case suggests that in a trivial flexion injury to the neck sustained in a car accident, which presents with serious neurological dysfunction, and where the standard diagnostic procedures are normal, the possibility of underlying congenital abnormality, such as Chiari I malformation should be considered.

Sports participation with Chiari I malformation

“…None of these patients were reportedly injured while participating in sports. There are several other case reports of patients with CM-I in which patients presented following severe 10,21,33,47 or more minor 1,2,5,6,12,18,31,38,45,50 trauma. None of the traumatic events described in these case reports involved athletic injury.…”

A case-control study of cerebellar tonsillar ectopia (Chiari) and head/neck trauma (whiplash)

“…Wan et al [9] described a symptomatic 'conversion' of previously asymptomatic Chiari Type I following minor head and neck trauma. Other authors have described the discovery of symptomatic Chiari Type I following motor vehicle crashes and what is typically described as 'whiplash' trauma [10,11], in which the injury mechanism is a result of inertial loading of the spine and skull [12].…”

Chiari I malformation mimicking myasthenia gravis

“…Recently, a presentation of a previously asymptomatic Chiari I malformation was reported following a flexion injury to the neck by a trivial car accident. 4 In our patient, it is possible that slight cervical trauma during anaesthesia for her adenoidectomy may have brought to light the underlying congenital abnormality.…”

“…1 2 Their expanding nature is demonstrated by their progressive clinical course and by the frequent complication of aqueduct stenosis and triventricular hydrocephalus. [2][3][4] We present a case of progressive midbrain syndrome associated with expanding cysts, which was successfully treated by neuroendoscopy.…”