Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content ++ Arnold-Chiari malformationChiari II malformationArnold-Chiari II ++ 348.4 Compression of brain742.2 Congenital reduction for deformities of brain ++ G93.5 Compression of brainQ04.8 Other specified congenital malformations of brainQ07.0 Arnold-Chiari syndromeQ07.00 Arnold-Chiari syndrome without spina bifida or hydrocephalusQ07.01 Arnold Chiari syndrome with spina bifidaQ07.02 Arnold-Chiari syndrome with hydrocephalusQ07.03 Arnold-Chiari syndrome with spina bifida and hydrocephalus ++ 5C: Impaired Motor Function and Sensory Integrity Associated with Nonprogressive Disorders of the Central Nervous System – Congenital Origin or Acquired in Infancy or Childhood +++ Description ++ Defect in cephalad portion of spinal columnHerniation of portions of the brainstem and spinal cord through the foramen magnum, including the cerebellum, medulla, and cervical spinal cord +++ Essentials of Diagnosis ++ Characteristic signs and symptoms with diagnosis confirmed by MRI +++ General Considerations ++ Most often occurs in presence of spina bifida +++ Demographics ++ 90% of patients with Chiari malformation also have hydrocephalusThree times more common in females than males2 +++ Signs and Symptoms ++ Respiratory difficultiesApneaCoughingStridorVision difficultiesNystagmusDiplopiaBlurred visionEsotropiaBradycardiaCranial nerve palsiesAtaxiaVertigoHydrocephalusHeadacheNeck painDecreased balanceSpasticity, numbness or tingling in handsPoor fine-motor skillsSlurred speechDevelopmental delay +++ Functional Implications ++ Delayed motor developmentDifficulty swallowingPoor balance +++ Possible Contributing Causes ++ Abnormality during fetal developmentTeratogensPossible genetic linkInfectionInsufficient maternal vitamins or minerals during gestation +++ Differential Diagnosis ++ Brain tumorSyringomyelia +++ Imaging ++ MRI ++ MRI positive for herniation of neural tissue into foramen magnum +++ Medical Procedures ++ TracheostomyGastrostomyPosterior fossa decompressionCervical laminectomy ++ GeneticistNeurologistOrthopedic surgeonOccupational therapistSpeech therapistAdmittance for surgical procedures, such asTracheostomy GastrostomyPosterior fossa decompressionCervical laminectomy ++ Delayed motor milestonesRolling SittingDecreased balance in sittingAdditional impairments typically associated with spina bifida ++ Pediatric Evaluation of Disability Inventory (PEDI)Manual muscle test ++ Therapy Child should avoid activities associated with risk for cervical injuryDevelopmental activities to facilitate gross motor developmentProne on elbowsRollingSittingBalance training ++ Patient will be able to:Stay prone on elbows for 30 seconds to increase strength in 2 monthsRoll prone-to-supine and supine-to-prone independently to increase mobility in 3 monthsProp self with hands on floor for 30 seconds with stand-by assistance to increase upright activities in 4 monthsSit independently for 1 minute with stand-by assistance to improve balance in 1 month ++ No effect on lifespan following ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPhysiotherapy 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPhysiotherapy Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options