Acute Vertigo After CrossFit Workout in a Young Woman With Chiari I Malformation

Abstract

CrossFit workout is associated with injuries mostly located over the spine and upper limb. Chiari I malformation (CIM) is characterized by migration of the cerebellar tonsils below the foramen magnum and this clinical condition has never been described after high-intense training such as CrossFit. A 19-year-old woman presented to the ED with acute vertigo, nausea, vomiting, and horizontal spontaneous nystagmus; symptoms began after an intense workout session. During neuro-otological examination, spontaneous positional left-beating horizontal nystagmus, normal response to bi-thermal caloric stimulations, and unremarkable cervical vestibular evoked myogenic potentials in both ears were observed; pure tone audiometry showed normal hearing. Central vertigo was suspected; therefore, an MRI was done, which identified a CIM. The patient's symptoms spontaneously improved at short term. The six-month follow-up MRI confirmed no changes. The subject completely stopped any training and remained asymptomatic over a 12-month follow-up. Our case report is the first describing CIM presented with acute vertigo after a high-intensity training.

Keywords: arnold-chiari malformation; case reports; exercise; high-intensity interval training; vertigo.

Figure 1. Cervical vestibular evoked myogenic potentials.

The patient had normal cervical vestibular evoked myogenic potentials in the right (a) and in the left (b) ear.

Figure 2. Coronal brain MRI.

Coronal brain MRI showing cerebellar tonsil herniation (arrow) through the foramen magnum.