Chiari I with Hydrocephalus

by

Igor T. Gavrilovic, MD

36 yo woman w/ progressively worsening headaches over 1 yr. Now they are more frequent (QOD) and bothersome. They are global and feel pressure-like. She was never evaluated for her HA. She gets into an MVA, has LOC, and is seen in a level 1 trauma ER. CT head shows moderate-sever hydrocephalus w/ lateral and 3rd ventricles >>> 4th ventricle. Neurosurgery called (in house) and recommends MRI ---> 15mm displacement of tonsils causing obstruction of CSF outflow and hydro. They recommend d/c home w/ appointment 12/30. Pt vomits x2. She has poor short-term memory, some mild perseveration, and brisk reflexes in legs.

I admitted this woman tonight under the Neurology service. But, I feel that I am babysitting her until an actual Neurosurgery Attending sees her scan and examines her in the AM.

How does one determine if a pt needs urgent decompression? Needless to say, I would be very surprised if she does not go to the O.R. sooner than later.....

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December 26, 2002

(c) 2002 Medical College of Georgia