A 16-year-old girl consulted because of neck pain and tingling and numbness in her fingers. She also complained of headache that worsens when she is coughing or straining in the toilet. Her neuro exam was normal except for slight weakness in her grip and occasional numbness in her fingers. 

MRI showed that she had Chiari I malformation. This is a condition wherein the “tonsils,” structures in the lower part of the brain, are found lower than they are supposed to be, resulting in compression of the brain and upper spinal cord. The treatment is surgery to relieve the compression. 

The patient underwent surgery to remove a small portion of the lower part of the skull in order to decompress the brain and spinal cord and give them extra space. She improved after the surgery, with relief of the headache and neck pain. Her grip also became stronger over time.