Pediatric Chiari I malformations - Do clinical and radiologic features correlate?

Background: Although Chiari I malformation is increasingly recognized in ch ildren, little is known about its clinical presentation in this age group. Objective: To evaluate the relationship between clinical and MRI features o f pediatric Chiari I malformations. Methods: We performed a chart review an d MRI analysis of 49 children with Chiari I malformation. The degree of ton sillar ectopia was compared with age at onset, presence of syringomyelia, a nd a neurologic severity score as follows: asymptomatic = 0, symptomatic wi th normal neurologic examination = 1, and symptomatic with abnormal examina tion = 2. Results: Age at onset of symptoms ranged from 10 months to 14 yea rs. Fifty-seven percent of patients were asymptomatic. Headache and neck pa in were the most frequent complaints. Syringomyelia was detected in 14% of patients and skull base abnormalities in 50%. The magnitude of tonsillar ec topia (5 to 23 mm) correlated with severity score (p = 0.04) but not with o ther clinical measures. Conclusions: The clinical symptoms of Chiari I malf ormations in children are nearly identical to those seen in adults. Childre n with greater amounts of tonsillar ectopia on MRI are more likely to be sy mptomatic.