Intended for healthcare professionals

Endgames Spot Diagnosis

A man with paraesthesia, headache, and vertigo

BMJ 2017; 359 doi: (Published 23 November 2017) Cite this as: BMJ 2017;359:j5165
  1. Jacob O Day, core medical trainee1,
  2. Pragnesh Bhatt, consultant neurosurgeon2
  1. 1Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
  2. 2Aberdeen Royal Infirmary, Aberdeen, UK
  1. Correspondence to J Day jacobday{at}

A 35 year old man presented to hospital with three months’ progressive paraesthesia of his right arm, leg, and torso. He also complained of intermittent headaches, particularly after coughing, and episodes of vertigo. Examination revealed hyperreflexia and numbness, with preserved joint position sense, in the right limbs. Magnetic resonance imaging (MRI) was performed (fig 1). What is the diagnosis?

Fig 1

Sagittal T2 weighted MRI scan of the neck and cervical spine

Short answer

Chiari malformation type 1. The MRI scan shows tonsillar descent characteristic of Chiari malformation type 1, and a resulting syringomyelia (fig 2).

Fig 2

Sagittal T2 MRI scan …

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