FLUCTUATING OCULOMOTOR SIGNS IN ARNOLD-CHIARI MALFORMATION - DIAGNOSTIC PITFALLS

Arnold-Chiari malformation can present with internuclear ophthalmopleg ia, sixth nerve paralysis, and transient or variable wave-form nystagm us. The differential diagnosis of a fluctuating ocular deviation shoul d include Arnold-Chiari malformation as well as myasthenia gravis and multiple sclerosis. Downward displacement of the cerebellum can even s imulate cerebellar atrophy on computed tomography. The presence of ske letal, lower motor neuron, and lower bulbar signs may alert the clinic ian. Once the etiology is suspected, magnetic resonance imaging (to in clude the foramen magnum) will determine the diagnosis. Clinical manag ement should be individually tailored. In our experience, one patient required foramen magnum decompression. A recession resection with adju stable sutures was performed in two patients.