Zespół Arnolda-Chiariego typu I – diagnostyka i leczenie – opis przypadku

Arnold-Chiari malformation is a congenital disorder of the atlanto-occipital peak. It is characterized by ectopy of the hindbrain structures below the foramen magnum. There are four forms of the Arnold-Chiari syndrome, which differ in the degree of developmental disorders. The incidence of this defect is estimated at 1/1000 births. Syringomyelia (spinal cavity) occurs in 24%–75% of cases. There are three groups of symptoms in the clinical picture. The fi rst is a group of symptoms of increased intracranial pressure. The second group includes the cerebellar symptoms caused by the compression of the cerebellum. The third group is the motor-sensory symptoms, usually quadriphatic, caused by the compression of the spinal cord. In cases where pressure symptoms or increased intracranial pressure are manifested, neurosurgical treatment should be undertaken. The CCOS (Chicago Chiari Outcome Scale) scale is used to assess the effectiveness of surgery. The scale consists of four categories: pain symptoms, non-pain symptoms, functionality, postoperative complications. The patient is assessed in each category on a four-level scale. The article contains a case report of a 54-year-old female patient hospitalised in the Neurology Department due to persistent headaches and cervicalgia. In addition, the patient reported persistent cough and a large amount of sputum in the bronchial tree. The cervical compression syndrome and degenerative changes were diagnosed initially. The intensifying ailments were the reason for the next hospitalisation and expending the diagnostic by brain MR, on the basis of which the Chiari type I syndrome was diagnosed. After the neurosurgical consultation, the patient was referred to the Department of Neurosurgery, where surgical treatment was performed. Then the patient was referred to the Department of Neurological Rehabilitation where, after the physiotherapy, a signifi cant improvement was achieved.