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

Tommy Lik Hang Chan; Kiven Vuong; Tara Chugh; Ian Carroll

doi:10.1016/j.heliyon.2021.e06795

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

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

Authors

Tommy Lik Hang Chan¹, Kiven Vuong², Tara Chugh³, Ian Carroll³

Affiliations

¹ Department of Clinical Neurological Sciences, Western University, Ontario, Canada.
² Western University, Ontario, Canada.
³ Department of Anesthesia, Stanford University, Palo Alto, California, USA.

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 leak in the differential based on clinical-radiological correlation and not solely on cerebellar tonsillar descent demonstrated on imaging.

Keywords: Cerebellar tonsillar descent; Cerebrospinal fluid leak; Chiari malformation type 1; Chronic headaches; Orthostatic headaches.

Publication types

Case Reports