Arnold-Chiari malformation type 1 is a congenital disease characterized by herniation of the cerebellar tonsils through the foramen magnum. Most common clinical symptom is pain, including occipital headache and neck pain, upper limb pain exacerbated by physical activity or valsalva maneuvers. Various otoneurological manifestations also occur in patients with the disease, which has usually associated with dizziness, vomiting, dysphagia, poor hand coordination, unsteady gait, numbness. Patients with Arnold-Chiari malformation may develop vertigo after spending some time with their head inclined on their trunk. Positional and down-beating nystagmus are common forms of nystagmus in them. We experienced a 12-year-old female who presented complaining of vertigo related to changes in head position which was initially misdiagnosed as a benign paroxysmal positional vertigo.
Arnold-Chiari Malformation ; Benign Paroxysmal Positional Vertigo ; Child ; Deglutition Disorders ; Dizziness ; Female ; Foramen Magnum ; Gait Disorders, Neurologic ; Hand ; Head ; Headache ; Humans ; Hypesthesia ; Motor Activity ; Neck Pain ; Palatine Tonsil ; Upper Extremity ; Valsalva Maneuver ; Vertigo ; Vomiting

OBJECTIVE: Brain atrophy and brain herniation are gaining a lot of attention separately, but a limited amount of studies connected them together, and because of this, we are going to review and examine the subject in the current meta-analysis. METHODS: The authors collected data reporting brain atrophy of alcoholic and schizophrenic cause, as well as data on control patients, all of which was published on MEDLINE between 1996 and 2018. The included 11 articles were processed with a statistical program. RESULTS: We found that the pericerebral space is unequal among the groups, while the intracranial volume is strongly correlated to the biggest foramen of the body. The effect of this inequality, however, is expressed in emergency cases, where the patients with brain atrophy will have more time before the final stage of brain herniation CONCLUSION: The current study raises a controversial issue that requires careful investigation and high attention from the health care personnel.
Alcoholics ; Atrophy ; Brain ; Delivery of Health Care ; Emergencies ; Foramen Magnum ; Humans ; Research Design ; Socioeconomic Factors ; Ticks

Dural arteriovenous fistula (D-AVF) at the foramen magnum is an extremely rare disease entity. It produces venous hypertension, and can lead to progressive cervical myelopathy thereafter. On the other hand, the venous hypertension may lead to formation of a venous varix, and it can rarely result in an abrupt onset of subarachnoid hemorrhage (SAH) when the venous varix is ruptured. The diagnosis of D-AVF at the foramen magnum as a cause of SAH may be difficult due to its low incidence. Furthermore, when the D-AVF is fed solely by the ascending pharyngeal artery (APA), it may be missed if the external carotid angiography is not performed. The outcome could be fatal if the fistula is unrecognized. Herein, we report on a rare case of SAH caused by ruptured venous varix due to D-AVF at the foramen magnum fed solely by the APA. A review of relevant literatures is provided, and the treatment modalities and outcomes are also discussed.
Angiography ; Arteries* ; Central Nervous System Vascular Malformations* ; Diagnosis ; Fistula ; Foramen Magnum* ; Hand ; Hypertension ; Incidence ; Rare Diseases ; Spinal Cord Diseases ; Subarachnoid Hemorrhage* ; Varicose Veins*

Rotatory vertebral artery syndrome (RVAS) is characterized by recurrent attacks of vertigo, nystagmus, and syncope induced by compression of the vertebral artery during head rotation. A 60-year-old man with atlas vertebrae fracture presented recurrent attacks of positional vertigo. Left-beat, upbeat and count clock-wise torsional nystagmus occurred after lying down and bilateral head roll (HR) showing no latency or fatigue. Magnetic resonance imaging revealed foramen magnum stenosis (FMS) and dominancy of right vertebral artery (VA). The flow of the right VA on transcranial Doppler decreased significantly during left HR. The slower the velocity was, the more the nystagmus was aggravated. RVAS can be evoked by FMS causing compression of the VA. And the nystagmus might be aggravated according to the blood flow insufficiency.
Constriction, Pathologic ; Deception ; Fatigue ; Foramen Magnum ; Head ; Humans ; Magnetic Resonance Imaging ; Middle Aged ; Spine ; Syncope ; Vertebral Artery ; Vertigo

No abstract available.
Foramen Magnum* ; Histiocytosis, Sinus* ; Spinal Cord Compression*

OBJECTIVE: The pathophysiology of idiopathic Chiari malformation (CM) type 1 is disturbance of free cerebrospinal fluid (CSF) flow and restoration of normal CSF flow is the mainstay of treatment. Additional migration of the medulla oblongata in pediatric patients is referred to as CM type 1.5, but its significance in adult patients is unknown. This study is to compare surgical outcomes of adult idiopathic CM type 1.5 with that of type 1. METHODS: Thirty-eight consecutive adult patients (M : F=11 : 27; median, 33.5; range, 18–63) with syringomyelia due to idiopathic CM type 1 were reviewed. Migration of the medulla oblongata was noted in 13 patients. The modified McCormick scale (MMS) was used to evaluate functional status before and one year after surgery. All patients underwent foramen magnum decompression and duroplasty. Factors related to radiological success (≥50% decrease in the diameter of the syrinx) were investigated. The follow-up period was 72.7±55.6 months. RESULTS: Preoperative functional status were MMS I in 11 patients and MMS II in 14 of CM type 1 and MMS I in 8 and II in 5 of CM type 1.5. Of patients with MMS II, 5/14 patients in group A and 3/5 patients in group B showed improvement and there was no case of deterioration. Radiological success was achieved in 32 (84%) patients and restoration of the cisterna magna (p=0.01; OR, 46.5) was the only significant factor. CONCLUSION: Migration of the medulla oblongata did not make a difference in the surgical outcome when the cisterna magna was restored.
Adult* ; Arachnoid ; Cerebrospinal Fluid ; Cisterna Magna ; Decompression ; Follow-Up Studies ; Foramen Magnum ; Humans ; Medulla Oblongata ; Rhombencephalon ; Syringomyelia

Chiari malformations are a congenital anomaly of the hindbrain. The most common, Chiari malformation type I (CM-I), is characterized by herniation of the cerebellar tonsils extending at least 3 mm below the plane of the foramen magnum. Consequently, CM-I is associated with hydrocephalus and symptoms involving compression of the cervicomedullary junction by ectopic tonsils. Several studies have reported the clinical symptoms associated with CM-I, including suboccipital headache, weakness in the upper extremities, facial numbness, loss of temperature sensation, ataxia, diplopia, dysarthria, dysphagia, vomiting, vertigo, nystagmus, and tinnitus. Syncope is one of the rarest presentations in patients with CM-I. There are many hypotheses regarding the causes of syncope in patients with CM-I; however, the mechanisms are not clearly understood. Although surgical decompression for CM-I in patients with syncope has yielded good clinical results in some studies, such cases are rarely reported. We report a case of orthostatic syncope in a patient with CM-I who was treated with surgical intervention.
Arnold-Chiari Malformation ; Ataxia ; Decompression, Surgical ; Deglutition Disorders ; Diplopia ; Dysarthria ; Foramen Magnum ; Headache ; Humans ; Hydrocephalus ; Hypesthesia ; Hypotension, Orthostatic ; Palatine Tonsil ; Rhombencephalon ; Sensation ; Syncope* ; Tinnitus ; Upper Extremity ; Vertigo ; Vomiting

Occasionally, a posterior fossa arachnoid cyst can induce compression of the spinal cord and cause syringomyelia. Here, we report the case of a 29-year-old man with both progressive shoulder pain and gait disturbance, who was found to have a huge retrocerebellar arachnoid cyst associated with syringomyelia. Accordingly, posterior fossa decompression and arachnoid cyst excision were performed. Post-operative MRI showed a marked reduction in the size of the arachnoid cyst and syringomyelia. The patient's symptoms were clearly improved compared to before surgery. In our view, treatment in such patients should focus on decompressing the foramen magnum and include the removal of the coexistent arachnoid cyst walls, which appear to be the crucial factor in development of syringomyelia. In this report, we discuss the pathogenic mechanisms underlying syringomyelia-associated retrocerebellar arachnoid cyst and review the current literature on this topic.
Adult ; Arachnoid* ; Decompression ; Foramen Magnum ; Gait ; Humans ; Magnetic Resonance Imaging ; Shoulder Pain ; Spinal Cord ; Syringomyelia*

The Chiari malformation is an infrequently detected congenital anomaly characterized by the downward displacement of the cerebellum with a tonsillar herniation below the foramen magnum that may be accompanied by either syringomyelia or hydrocephalus. Surgery, such as foramen magnum decompression, is indicated for a symptomatic Chiari malformation, although an incidental lesion may be followed-up without further treatment. Infrequently, increased intracranial pressure emerges due to hyperthyroidism. A nineteen-year-old girl visited our outpatient clinic presented with a headache, nausea and vomiting. A brain and spinal magnetic resonance image study (MRI) indicated that the patient had a Chiari I malformation without syringomyelia or hydrocephalus. An enlarged thyroid gland was detected on a physical examination, and serum markers indicated Graves' disease. The patient started anti-hyperthyroid medical treatment. Subsequently, the headache disappeared after the medical treatment of hyperthyroidism without surgical intervention for the Chiari malformation. A symptomatic Chiari malformation is indicated for surgery, but a surgeon should investigate other potential causes of the symptoms of the Chiari malformation to avoid unnecessary surgery.
Ambulatory Care Facilities ; Biomarkers ; Brain ; Cerebellum ; Decompression ; Encephalocele ; Female ; Foramen Magnum ; Graves Disease ; Headache ; Humans ; Hydrocephalus ; Hyperthyroidism* ; Intracranial Hypertension* ; Intracranial Pressure ; Nausea ; Physical Examination ; Syringomyelia ; Thyroid Gland ; Unnecessary Procedures ; Vomiting

Sex determination is considered the first and most important process in the identification of unknown skeletal remains. The skull is one of bones with high accuracy to discriminate sexes, but there is no dimorphic studies of Korean skull by discriminant function analysis. The aim of this study was to build and provide an easy and accurate discriminant equation to sex determination by using three-dimensional skull images of Korean. Computed tomography images from 102 cadavers were reconstructed three-dimensional images by computer program. We measured 44 variables using the template in computer program and variables were sorted out items with high accuracy and reliability by intraclass correlation coefficient (ICC), Cohen's d value, and receiver operating characteristic (ROC) curve. The equation with the highest accuracy had 82.7% in males, 82.2% in females, it was constituted bizygomatic diameter, cranial base length, biauricular breadth, upper facial breadth, frontal chord, foramen magnum breadth, and right mastoid length. The cross-validated accuracy had 76.5%~86.7% using 3D skull images in Koreans. The value of variables that matches the other population group study, most of variables had a statistically significant difference among population groups. Male skulls in Koreans were smaller than those in European and female skulls were bigger than in Asian. This result should be helpful to determine sex in Koreans.
Asian Continental Ancestry Group ; Cadaver ; Female ; Foramen Magnum ; Humans ; Imaging, Three-Dimensional* ; Male ; Mastoid ; Population Groups ; ROC Curve ; Skull Base ; Skull*