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Motion of the cerebellar tonsils in Chiari type I malformation studied by cine phase-contrast MRI

From the Magnetic Resonance Center of Pedralbes (Drs. Pujol and Capdevila), Barcelona; the Department of Neurology (Drs. Roig, Marti-Vilalta, Kulisevsky, and Escartin), Santa Creu i Sant Pau Hospital, Autonomous University of Barcelona; the Department of Neurology (Dr. Pou), Ntra. Sra. del Mar Hospital, Autonomous University of Barcelona, Spain; and General Electric (Dr. Zannoli), Buc, France.
Supported in part by the Conselleria de Sanitat de la Generalitat de Catalunya (Autonomous Government of Catalonia, Spain) and the Institut de Recerca de l'Hospital de la Santa Creu i Sant Pau of Barcelona.
Received November 1, 1994. Accepted in final form February 3, 1995.
Address correspondence and reprint requests to Dr. Jesus Pujol, Magnetic Resonance Center of Pedralbes, Monestir, 3, 08034 Barcelona, Spain.

We studied the effects on CSF dynamics at the foramen magnum and the clinical significance of the abnormal tonsillar motion in 14 patients with Chiari type I malformation and 14 control subjects using cine phasecontrast MRI.Dynamic MRI consisted of axial and sagittal cine phase-contrast sequences. CSF and tonsillar motion were qualitatively and quantitatively evaluated, and the subarachnoid space at the foramen magnum measured. In Chiari patients, cine phase-contrast MRI detected the abnormal pulsatile motion of the cerebellar tonsils, which produced a selective obstruction of CSF flow from the cranial cavity to the spine. The amplitude of the tonsillar pulsation and the severity of the arachnoid space reduction were associated with the symptom of cough-strain headache, but not with the presence of syringomyelia. The finding of abnormal valve dynamics of the cerebellar hernia revealed by cine phase-contrast MRI conforms to the pathophysiologic mechanisms suggested in pressure register studies and opens a new possibility in the presurgical assessment of Chiari patients with exertional symptoms.

NEUROLOGY 1995;45: 1746-1753

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