Adult Chiari Type I Malformation Presenting as Dysphagia

The authors describe a rare case of Chiari type I malformation presenting as persistent dysphagia. A fifty-eight year-old woman showing a nearly one-year history of swallowing difficulty was transferred to our department for neurological evaluation of aspiration pneumonia. Neurological examination revealed absence of bilateral gag reflexes, and mild weakness of the right upper extremity. Magnetic resonance images showed typical features of Chiari I malformation combined with spinal cord compression due to cervical spondylosis at four intervertebral levels from C3/4 to C6/7. Neither hydrocephalus nor syringomyelia was associated. Decompression of the foramen magnum combined with expansive laminoplasty of C2 through C7 was performed. Dysphagia and abnormal gag reflex improved within 1 week after surgery. Thus, awareness of the Chiari type I malformation as a cause of dysphagia in its adult symptomatology will lead to correct diagnosis of the pathology in its early stage.