Arnold–Chiari malformation type 1 complicated by sudden onset anterior spinal artery thrombosis, tetraparesis and respiratory arrest

• Published in: BMJ case reports Vol. 2011; no. apr15 1; p. bcr0720103170
• Main Authors: Wani, Abdul Majid, Zayyani, Najah R, Al Miamini, Wail, Khoujah, Amer M, Alharbi, Zeyad, Diari, Mohd S
• Format: Journal Article
• Language: English
• Published: England BMJ Publishing Group LTD 15-04-2011; BMJ Publishing Group
• Series: Unusual association of diseases/symptoms
• Subjects: Adult; Anterior Spinal Artery Syndrome - diagnosis; Anterior Spinal Artery Syndrome - etiology; Arnold-Chiari Malformation - complications; Arnold-Chiari Malformation - diagnosis; Associations; Brain damage; Female; Headaches; Humans; Intensive care; Magnetic Resonance Imaging; Middle East; Ostomy; Pain; Paresis - etiology; Persistent Vegetative State - etiology; Respiratory Insufficiency - etiology; Spinal cord; Spinal manipulation; Thromboembolism; Thrombosis; Unusual Association of Diseases/Symptoms; Veins & arteries
• ISSN: 1757-790X; 1757-790X
• DOI: 10.1136/bcr.07.2010.3170

Chiari in 1891 described a constellation of anomalies at the base of the brain inherited congenitally, the characteristic of which are (1) extension of a tongue of cerebellar tissue posterior to the medulla and cord that extends into the cervical spinal canal; (2) caudal displacement of the medulla and the inferior part of the fourth ventricle into the cervical canal; and (3) a frequent but not invariable association with syringomyelia or a spinal developmental abnormality. Chiari recognized four types of abnormalities. Presently, the term has come to be restricted to Chiari’s types I and II, that is, to cerebellomedullary descent without and with a meningomyelocele, respectively. The association of Arnold–Chairi malformation and high cervical cord infarction is unusual. The most common syndrome, anterior spinal artery syndrome (ASAS), is caused by interruption of blood flow to the anterior spinal artery, producing ischaemia in the anterior two-thirds of the cord, with resulting neurologic deficits. Causes of ASAS include aortic disease, postsurgical, sepsis, hypotension and thromboembolic disorders. The authors present an interesting case of cervical cord infarction due to anterior spinal artery thrombosis in a patient of type 1 Arnold–Chiari malformation without any of the above predisposing factors.