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  • Arnold-Chiari malformation
  • Chiari II malformation
  • Arnold-Chiari II

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  • 348.4 Compression of brain
  • 742.2 Congenital reduction for deformities of brain

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Description

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  • Defect in cephalad portion of spinal column
  • Herniation of portions of the brainstem and spinal cord through the foramen magnum, including the cerebellum, medulla, and cervical spinal cord

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Essentials of Diagnosis

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  • Characteristic signs and symptoms with diagnosis confirmed by MRI

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General Considerations

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Demographics

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  • 90% of patients with Chiari malformation also have hydrocephalus
  • Three times more common in females than males2

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Signs and Symptoms

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Functional Implications

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  • Delayed motor development
  • Difficulty swallowing
  • Poor balance

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Possible Contributing Causes

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  • Abnormality during fetal development
  • Teratogens
  • Possible genetic link
  • Infection
  • Insufficient maternal vitamins or minerals during gestation

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Differential Diagnosis

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Imaging

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Medical Procedures

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  • Geneticist
  • Neurologist
  • Orthopedic surgeon
  • Occupational therapist
  • Speech therapist
  • Admittance for surgical procedures, such as
    • Tracheostomy
    • Gastrostomy
    • Posterior fossa decompression
    • Cervical laminectomy

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  • Delayed motor milestones
    • Rolling
    • Sitting
  • Decreased balance in sitting
  • Additional impairments typically associated with spina bifida

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  • Therapy
  • Child should avoid activities associated with risk for cervical injury
  • Developmental activities to facilitate gross motor development
    • Prone on elbows
    • Rolling
    • Sitting
  • Balance training

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  • Patient will be able to:
    • Stay prone on elbows for 30 seconds to increase strength in 2 months
    • Roll prone-to-supine and supine-to-prone independently to increase mobility in 3 months
    • Prop self with hands on floor for 30 seconds with stand-by assistance to increase upright activities in 4 months
    • Sit independently for 1 minute with stand-by assistance to improve balance in 1 month

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  • No effect on lifespan following surgical repair

1. The American Physical Therapy ...

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