Abnormal Eye Movement


Consult Page

5Y female presenting with eye movement abnormalities. MRI with Chiari malformation.

Initial Imaging

Fig. 67.1, Sagittal T2-weighted MRI of the brain without contrast demonstrates cerebellar tonsillar ectopia with crowding of the foramen magnum and 11 mm of downward tonsillar herniation. There is no spinal cord or brainstem signal abnormality.

Walking Thoughts

  • What type of eye movement abnormality does she have? Does she have any other symptoms (e.g. headache, paresthesias, weakness)?

  • Does the patient have any signs or symptoms of hydrocephalus?

  • Does the patient have any signs or symptoms of brainstem compression?

  • Do these symptoms worsen with Valsalva maneuvers?

  • Does the patient’s history and exam correlate with the imaging findings? Is she symptomatic from her Chiari I malformation or is it an incidental finding?

  • What is her prior medical history? Does she have any congenital malformations (e.g. spina bifida)?

  • Does she need additional imaging (e.g. MRI of the spine)?

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