Is Chiari malformation a cause of systemic hypertension and sinus bradycardia? A case report and literature review

Abstract

A middle aged woman, having a history of diastolic hypertension and sinus bradycardia since one year ago, was referred to our center with a sudden occipital headache after shouting. To evaluate the cause of headache the brain MRI was performed reporting a slight cerebellar tonsillar herniation of about one centimeter below the foramen magnum. After the patient was diagnosed to have type I Chiari malformation, a surgery procedure was done and the symptoms were recovered after that.Type I Chiari malformation is a disease mostly caused by congenital displacement of cerebellar tonsils through the foramen magnum. The most common symptom is headache, rarely reported with hypertension or sinus bradycardia.

Keywords: Arnold-Chiari Malformation; Bradycardia; Headache Disorders; Hypertension.

Figure 1

(Before the surgery) Midsagittal T₂-weighted MRI shows tonsillar herniation of about one centimeter (the arrow) below the hard palateforamen magnum line (the line). Also, no Syrinx and no hydrocephaly or deformity of 4^th ventricle is noticed.

Figure 2

(After the surgery) The occipital craniectomy scar (the arrow) and tonsillar upward migration above hard plate-foramen magnum line (the line), with dilation of foramen magnum and reduction of stenosis were seen. No syrinx, stenosis, and compression were found in the MRI study after the surgery.