Chiari malformation and tuberculous meningitis: aetiology and management

• Published in: BMJ case reports Vol. 2018; p. bcr-2018-224245
• Main Authors: Diestro, Jose Danilo Bengzon, Bautista, Jesi Ellen Cueto, Omar II, Abdelsimar T, Mercado, James Garcia, Ramiro, Philip Asuncion
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group 05-04-2018
• Series: Case Report
• Subjects: Arnold-Chiari Malformation - diagnosis; Arnold-Chiari Malformation - physiopathology; Arnold-Chiari Malformation - rehabilitation; Arnold-Chiari Malformation - therapy; Cranial Fossa, Posterior - diagnostic imaging; Cranial Fossa, Posterior - surgery; Decompression, Surgical - methods; Disease Progression; Female; Fever - etiology; Headache - etiology; Humans; Magnetic Resonance Imaging; Spinal Puncture; Treatment Outcome; Tuberculosis, Meningeal - diagnosis; Tuberculosis, Meningeal - physiopathology; Tuberculosis, Meningeal - rehabilitation; Tuberculosis, Meningeal - therapy; Unusual Association of Diseases/Symptoms; Vertigo - etiology; Vomiting - etiology; Young Adult; tb and other respiratory infections; brain stem / cerebellum; hydrocephalus; neurosurgery; meningitis
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr-2018-224245

This is the first reported case of a Chiari 1 malformation in association with tuberculous (TB) meningitis. We present a case of a 23-year-old woman with a 2-week history nocturnal fever, vertigo, headache and projectile vomiting. She had nystagmus, scanning speech, bilateral papilloedema and ataxia. Cranial imaging showed a 10 mm tonsillar herniation. Posterior fossa decompression was done. Because the patient’s gamut of symptoms was highly suspicious for a central nervous system infection, a lumbar tap was done which revealed TB meningitis. Four years later, after anti-TB medications and rehabilitation, all her symptoms except gait instability resolved.