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Journal of The Korean Society of Emergency Medicine 2006;17(3): 277-279. |
| Syncope Associated with Type 1 Arnold-Chiari Malformation |
| Sun Ah Park, Hoon Lim, Jeong Ho Park, Tae Kyeong Lee, Ki Bum Sung |
1Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, Korea. sapark@schbc.ac.kr
2Department of Emergency Medicine, Soonchunhyang University Bucheon Hospital, Bucheon, Korea. |
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| ABSTRACT |
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A type I Arnold-Chiari malformation (ACM1) is characterized by herniation of cerebellar tonsils at least 3 mm below the plane of the foramen magnum and can present with various clinical symptoms, frequently occipital headache, lower cranial nerve palsy, or ataxia. However, syncope has rarely been described as an initial manifestation of ACM1. An 18-year-old girl experienced a falling to the ground with a loss of consciousness for a minute. The fall occurred with a sensation of vertigo when she was extending her neck to pick up a shuttlecock. Electroencephalography, autonomic function tests, and echocardiography did not demonstrate abnormalities. An magnetic resonance image showed a ACM1. A second-degree atrioventricular block was noted on the initial 24-hour EKG, but not on the second and the third ones taken after neck movement had been restricted by a brace. The initiation of syncope with a sensation of vertigo during excessive head movement and the absence of any other common causes of syncope except for the transient second-degree atrioventricular block disappearing after restriction of neck movement raise the possibility that the syncope was due to the ACM1. Therefore, we recommend that a differential diagnosis of syncope should include ACM1 on the initial evaluation. |
| Key words:
Arnold-Chiari Malformation, Magnetic Resonance Imaging, Syncope |
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