title: Progressive, asymptomatic papilledema as the presenting sign of a Chiari I malformation.
abstract: BACKGROUND
  Chiari I malformation (CM1) is the caudal herniation of the cerebellar tonsils into the foramen magnum. It can cause several neurological signs and symptoms, or be asymptomatic. Papilledema is a potential, but unusual, manifestation of CM1. While CM1 is often asymptomatic, papilledema is less likely to be. We present the first reported case of a progressive, asymptomatic papilledema as the sole presenting sign of a CM1;
  
  
  METHODS
  A 39 year old woman presented without neurological symptoms and was found to have optic disc edema. Humphrey visual fields were normal and B-scan showed no drusen. On a subsequent visit, optical coherence tomography showed advanced disc edema. Neuroimaging revealed a CM1. The patient was referred for neurological consultation for the management of the papilledema secondary to CM1;
  
  
  CONCLUSIONS
  This case represents the importance of a thorough ocular examination, as the patient's asymptomatic neurologic condition would not have been diagnosed without the discovery of the papilledema.
authors.affiliation: Illinois College of Optometry, 3241 S. Michigan Ave, Chicago, IL 60616, USA. wstone@ico.edu
authors.forename: Wendy J
authors.initials: WJ
authors.lastname: Haaland Stone
authors.forename: Erica A
authors.initials: EA
authors.lastname: Ittner
authors.forename: Bruce A
authors.initials: BA
authors.lastname: Teitelbaum
authors.forename: Leonard V
authors.initials: LV
authors.lastname: Messner
mesh_terms: D000328:Adult; D001139:Arnold-Chiari Malformation / Q000150:complications / Q000175:diagnosis*; D002526:Cerebellar Diseases / Q000150:complications* / Q000175:diagnosis; D003937:Diagnosis, Differential; D005260:Female; D005539:Foramen Magnum; D006547:Hernia / Q000150:complications* / Q000175:diagnosis; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D009898:Optic Disk / Q000473:pathology*; D010211:Papilledema / Q000175:diagnosis / Q000209:etiology*