SEE-SAW NYSTAGMUS IN CHIARI MALFORMATION TYPE I

OLEH:St. Suleha Umar

PEMBIMBING:Dr. dr. Batari Todja Umar, Sp.M (K)

dr. Yunita, Sp.M, M.Kes

Case Report

Purpose: To report a case of 25 years old woman with see saw nystagmus as a manifestation of Chiary’s Malformation Type I

Design & Methods: A case report of a 25 year-old woman referred with involuntary movements of both eyes. Visual acuity was assessed, anterior and posterior segments were examined. The patient then underwent magnetic resonance imaging of head and brainstem.

ABSTRACT

Result: See saw nystagmus was evident. Best corrected visual acuity were 6/6 in both eyes. Anterior and posterior segments of the eye were normal. Cranial nerve testing was unremarkable. Chiari malformation was confirmed by magnetic resonance imaging. The patient was diagnosed as Chiari Malformation Type I. The patients then reffered to neurologist but no treatment was given.

Conclussion: See saw nystagmus can be found in Chiary Malformation Type I. Treatment of Chiari Malformation Type I depends on the form, severity and associated symptoms. Regular monitoring, medications and surgery are treatment options. In some cases, no treatment is needed.

ABSTRACT

Involuntary movement on both eyes

Since 3 years before

Woman

25 years-old

Eye Movement examination was fine. See-Saw Nystagmus was

evident

Anterior and posterior segment of both eyes shows normal appearance

Visual

Acuity

6/15 and

6/12

No history of

ophthalmic disturbance found before.

CASE REPORT

EYE MOVEMENTS

CASE REPORT

Fig.1 Magnetic Resonance Imaging

Shows a cerebellar tonsils displaced approximately 13,8mm below the level of the foramen magnum.

CASE REPORT

Cerebellar Tonsil

Reffered to Neurology Department

No spesific treatment from Neuro-Ophthalmology department

Cerebellar tonsil through the foramen magnum

Examination and Neuroimaging

See-Saw Nystagmus

CASE REPORT

Clinical symptoms consists of a mixture of symptoms of spinal cord dysfunction, symptoms of brainstem disorder, and cerebellar symptoms were depressed.

Prevalence of Chiari malformation is 1 per 1000 to 1 per 5000. Most of the patients are asymptomatic. Incidence of symptomatic Chiari are less and unknown.

Hind brain that overcrowding into an underdeveloped posterior cranial fossa (PCF)

Congenital or Acquired

Chiari Malformation

Type I

This patient was diagnosed with Chiari Malformation Type I because on Magnetic Resonance imaging examination was found the tonsil of cerebellar go through the foramen magnum with 13,8mm length

Treatment is usually reserved only for symptomatic patients or those with a syrinx. It consists of decompressing the posterior fossa, by removing part of the occipital bone.

DISCUSSION

Diagram Chiari Measurement

Anterior

margin

Posterior

Margin

DISCUSSION

Table 1. Ocular Disturbance with the Chiari I Malformation

DISCUSSION

DISCUSSIONCOMPLICATIONS

CMI causes neurological dysfunction by direct compression of the neural tissue at the craniovertebral junction or cerebrospinal fluid disturbances that give rise to syringomielia or hydrocephalus.

In this patient we found only Chiari malformation without syringomyelia. And the clinical symptoms related was see-saw nystagmus.

Localizing central nervous system nystagmus or Acuired Types.

Involuntary Eye Movement

Non localizing central nervous system nystagmus or Infantile Types.

JERK or PENDULARJerk has a slow phase then followed by fast phase in the opposite direction.Pendular has equal velocity, slow phase movement in both directions.

See-Saw Nystagmus

Dysconjugate vertical movements, upward moving eye intorts, downward eye extorts

Non SurgicalOptical devices, medical treatment, acupunture.

Surgical

DISCUSSION

NYSTAGMUS

See-saw nystagmus has been seen with tumors of the parasellar region and diencephalon, brain-stem vascular lesions, syringobulbia, and after trauma. And very rare found in CM1

DISCUSSION

The treatment for nystagmus in this patient was not conducted simply because the patient was not complaining of oscilopsia since the nystagmus was only appear on lateral extreme gaze

DISCUSSION

If the patient is clinically asymptomatic and no syringomyelia, should be observed first as we found in this patient.

Therapy of choice is continued clinical monitoring and surgical intervention.

Surgery is performed craniectomy of posterior fossa and cervical laminectomy for decompression.

The patient we reffered to neurology and no treatment was given.The patient was satisfied with prescribed glasses and no other complain.

Regular monitoring, medications and surgery are treatment options. In some cases, no treatment is needed.

2

3

See saw nystagmus can be found in Chiary Malformation Type I

1

Treatment of Chiari Malformation Type I depends on the form, severity and associated symptoms.

CONCLUSSION

THANK YOU