Presentation
Headaches and vertigo in a diabetic patient.
Patient Data
Caudal descent of the cerebellar tonsils through the foramen magnum, located 14 mm below the McRae line on sagittal sequences. There is also associated caudal herniation of the medulla oblongata. Mild to moderate enlargement of the lateral ventricles.
Small vessel ischemic changes are noted.
No associated syrinx of the cervical cord on the sagittal sequences.
Degenerative disc disease at C6-7 with Modic type 2 changes.
Small calcified nodule in the subcutaneous tissue of the scalp (trichilemmal cyst).
Case Discussion
MRI features of Chiari 1.5 malformation with no syrinx of the cervical spinal cord.
Chiari 1.5 malformation is defined as a combination of cerebellar tonsillar herniation (as seen in Chiari I malformation) along with caudal herniation of some portion of the brainstem (often obex of the medulla oblongata) through the foramen magnum. It is considered a progression of Chiari I malformation.
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