SPINAL-CORD INJURY WITHOUT RADIOGRAPHIC ABNORMALITY AND CHIARI MALFORMATION

Spinal cord injury without radiographic abnormality and asymptomatic C hiari I malformation have an unusual coincidence. A young boy who had recently fallen from his porch was transferred to the neurosurgery ser vice with a high cervical central cord syndrome. Careful study demonst rated no radiographic abnormality and, although the patient was previo usly quite well, magnetic resonance imaging revealed Chiari I malforma tion. Although expectedly uncommon, reports of three other similar cas es support a less than independent relationship between these two proc esses. All four children, each aged 2 years, were premorbidly asymptom atic and were playing when they fell from low elevations; two were on a couch. All were evaluated by primary authorities 12 to 48 hours befo re definitive admission, and all had normal plain film examinations. T hree of the four children suffered injuries in flexion, the fourth in extension. Three realized a 5-minute to 3-hour delay before the onset of symptoms, and three suffered gradual progression of deficit. Magnet ic resonance imaging was the most commonly applied and productive diag nostic medium, demonstrating cerebellar ectopia in three of three case s. Two children were surgically treated, and all achieved at least a f unctional outcome. Similarities among these cases support a common mec hanism of injury, and indicate careful counseling in children with asy mptomatic Chiari I malformation and consideration of operative decompr ession in those children with progressive neurological injury and defi cit.