title: Intracranial Hypertension in a Patient with a Chiari Malformation Accompanied by Hyperthyroidism.
abstract: The Chiari malformation is an infrequently detected congenital anomaly characterized by the downward displacement of the cerebellum with a tonsillar herniation below the foramen magnum that may be accompanied by either syringomyelia or hydrocephalus. Surgery, such as foramen magnum decompression, is indicated for a symptomatic Chiari malformation, although an incidental lesion may be followed-up without further treatment. Infrequently, increased intracranial pressure emerges due to hyperthyroidism. A nineteen-year-old girl visited our outpatient clinic presented with a headache, nausea and vomiting. A brain and spinal magnetic resonance image study (MRI) indicated that the patient had a Chiari I malformation without syringomyelia or hydrocephalus. An enlarged thyroid gland was detected on a physical examination, and serum markers indicated Graves' disease. The patient started anti-hyperthyroid medical treatment. Subsequently, the headache disappeared after the medical treatment of hyperthyroidism without surgical intervention for the Chiari malformation. A symptomatic Chiari malformation is indicated for surgery, but a surgeon should investigate other potential causes of the symptoms of the Chiari malformation to avoid unnecessary surgery.
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chang Hwan
authors.initials: CH
authors.lastname: Pang
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Soo Eon
authors.initials: SE
authors.lastname: Lee
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chi Heon
authors.initials: CH
authors.lastname: Kim
authors.affiliation: Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Chun Kee
authors.initials: CK
authors.lastname: Chung
keywords: Chiari malformation; Headach; Hyperthyroidism; Intracranial hypertension