Arnold-Chiari malformation with syringomyelia in an elderly woman

Presentation: a 76 year-old woman, complaining of leg pain and unsteady gai t for 3 years, presented with a spastic paraparetic gait, severe spasticity and touch, thermal and pain sensory loss limited to arms, lower thorax and upper abdomen. Brain and spinal cord magnetic resonance imaging showed a l arge loculated syrinx. Cerebellar tonsillar herniation into the foramen mag num was also seen (Amold-Chiari malformation, type I). Outcome: the patient had successful cervico-spinal surgical decompression w hich resulted in marked reduction in hypertonia and weakness, normal gait a nd normal joint movement at 6 months. Conclusion: this unusual, late clinical presentation of a congenital diseas e underlines the importance of a comprehensive diagnostic work-up in the el derly patients with complex neurological signs.