International Medical Case Reports Journal (Nov 2020)
Acute Visual Loss Secondary to Arnold Chiari Type I Malformation Completely Resolving After Decompressive Posterior Fossa Surgery
Abstract
Chrysoula Florou,1 Konstantinos Andreanos,1 Nikos Georgakoulias,2 Edroulfo Espinosa,2 Evangelia Papakonstantinou,1 Ilias Georgalas,1 Tryfon Rotsos1 1Department of Ophthalmology, University of Athens, G Gennimatas General Hospital, Athens, Greece; 2Neurosurgery Department, G Gennimatas General Hospital, Athens, GreeceCorrespondence: Tryfon RotsosDepartment of Ophthalmology, University of Athens, G Gennimatas General Hospital, Alkmanos 15 Street, Athens 11528, GreeceTel +306974727279Email [email protected]: We describe the case of a 22-year-old woman of southeast-Asian origin, presenting with unilateral sudden visual loss after a self-healing hearing loss a week before. Ophthalmological examination showed visual acuity of light perception in the left eye, mild RAPD, normal ocular motility and an elevated optic disc with indistinct margins. Neurological examination showed no acute pathology and brain CT-MRI imaging revealed a small-almost subclinical-herniation of the cerebellar tonsils. As investigation eliminated every other infectious or inflammatory cause of papillitis, neurosurgical intervention was proposed. The patient underwent an uncomplicated occipital craniotomy with posterior fossa decompression and had a favorable revolution with regression of papilledema and a fully recovering visual acuity that reached 20/20. Chiari malformation type I refers to an abnormality of the posterior fossa that has a smaller volume than normal, leading to the herniation of cerebellar tonsils, at least 5 mm below the foramen magnum. The occurrence of papilledema associated with Chiari malformation type 1 is rare. Chiari malformation has, until today, mainly been studied among children populations, usually with a poor visual acuity recovery. The originality of our case report consists in the description of an adult patient case showing unilateral, unusual ophthalmological findings and complete recovery after surgical treatment.Keywords: Arnold Chiari malformation type I, herniation of cerebellar tonsils, elevated optic disc, papilledema