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Case Reports
. 2019 Apr-Jun;14(2):598-601.
doi: 10.4103/ajns.AJNS_33_19.

Resolution of Papilledema Associated with Chiari I Malformation with Ventriculoperitoneal Shunting

Imran Jivraj  1 , Grant Liu  1 , Nikhil Sharma  2 , Gregory Glauser  2 , Michael Sean Grady  2 , Neil Rainer Malhotra  2
Affiliations
Case Reports

Resolution of Papilledema Associated with Chiari I Malformation with Ventriculoperitoneal Shunting

Imran Jivraj et al. Asian J Neurosurg. 2019 Apr-Jun.

Abstract

Chiari malformation type 1 (CMI) usually presents with cervical pain and suboccipital headache, among other symptoms. Patients with CMI describe symptoms that are clearly correlated with CMI for an average of 3.1 years before diagnosis. We present a case of a patient with bilateral papilledema and CMI but with no long-standing CMI symptoms. She was initially diagnosed with a concussion but developed unremitting intense occipital headaches 4 days later which prompted an evaluation for an alternative diagnosis. Treatment of this case was ventriculoperitoneal shunting, which may serve as an alternative to posterior fossa decompression under certain circumstances.

Keywords: Chiari I malformation; papilledema; ventriculoperitoneal shunting.

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Conflict of interest statement

There are no conflicts of interest.

Figures

Figure 1
Figure 1
Fundus photography (a and b) and formal visual field testing (c and d) at presentation. At presentation, our patient had evidence of severe papilledema with retinal hemorrhages, cotton wool spots, and retinal venous tortuosity (a and b). Humphrey 30-2 visual fields demonstrated severe global depression involving fixation bilaterally (c and d)
Figure 2
Figure 2
Initial (a) and follow-up (b) magnetic resonance imaging demonstrating CMI. (a) First magnetic resonance imaging November 2016. (b) Second and f/u magnetic resonance imaging January 2018, no change in Chiari malformation, tonsillar herniation, or foramen magnum compression however with dramatic clinical improvement
Figure 3
Figure 3
Fundus photography (a and b) and formal visual field testing (c and d) after 16 months of follow-up. After 16 months of follow-up, there was a persistent resolution of papilledema with mild gliosis of both optic nerves (a and b). Humphrey 30-2 visual field demonstrated mild enlargement of both blind spots and nonspecific depression (c and d)
See this image and copyright information in PMC

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