Thursday, May 13, 2021

Cerebellar tonsillar descent: A diagnostic dilemma between Chiari malformation type 1 and spinal cerebrospinal fluid leak

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Heliyon. 2021 Apr 19;7(4):e06795. doi: 10.1016/j.heliyon.2021.e06795. eCollection 2021 Apr.

ABSTRACT

Cerebellar tonsillar descent can be seen on head magnetic resonance imaging in both Chiari malformation type 1 and spinal cerebrospinal fluid leak creating the potential for misdiagnosis. We report five cases of spinal cerebrospinal fluid leak at Stanford University initially misdiagnosed and treated as Chiari malformation type 1 based on cerebellar tonsillar descent demonstrated on imaging. All five cases had sustained relief at the 6-month follow up visit from epidural blood patches for the treatment of spinal cerebrospinal leak after unsuccessful suboccipital decompression surgeries. A misdiagnosis of Chiari malformation type 1 in patients with spinal cerebrospinal fluid leak may lead to unnecessary surgeries instead of the less invasive treatment, such as epidural blood patches. It is imperative to consider a spinal cerebrospinal fluid lea k in the differential based on clinical-radiological correlation and not solely on cerebellar tonsillar descent demonstrated on imaging.

PMID:33981879 | PMC:PMC8082209 | DOI:10.1016/j.heliyon.2021.e06795

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