title: Spontaneous Improvement of Chiari I Malformation and Syringomyelia in a Patient With Cystic Fibrosis: Case Report.
abstract: BACKGROUND
  Syringomyelia is highly associated with Chiari I malformation, but the pathophysiologic mechanism of syrinx formation and its relation to downward cerebellar tonsillar displacement remains elusive. Cough, Valsalva maneuver, and other physiological strains transiently exacerbate the clinical symptoms of these conditions, exert profound effects on the flow dynamics across the craniospinal junction, and are thought to play an important role in the pathogenesis of syringomyelia.
  
  
  METHODS
  We report the case of a patient with cystic fibrosis who presented during an exacerbation of bronchiectasis and was found to have a Chiari I malformation with associated syringomyelia. Eight months later, when the patient had returned to baseline pulmonary status, repeat imaging showed interval improvement in both the size of the syrinx and descent of cerebellar tonsils.
  
  
  CONCLUSIONS
  This rare case of spontaneous improvement of syringomyelia and Chiari I malformation attributable to relief from chronic cough offers interesting insight into the mechanism of these disorders.
  
  
  BACKGROUND
  FEV1, forced expiratory volume in 1 secondFVC, forced vital capacity.
authors: Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts.
authors: Arjun R
authors: AR
authors: Khanna
authors: Jean-Valery
authors: JV
authors: Coumans
mesh_terms: D001139:Arnold-Chiari Malformation / Q000150:complications / Q000175:diagnosis*; D003550:Cystic Fibrosis / Q000150:complications / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008875:Middle Aged; D012075:Remission, Spontaneous; D013595:Syringomyelia / Q000150:complications / Q000175:diagnosis*