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A 12 year-old girl presented with posterior headaches. Examination was notable for downbeat nystagmus.
T1-weighted sagittal MRIl. Note in the Chiari malformation that the brainstem and cerebellar tonsils descend below the foramen magnum. There are various types of Chiari malformations. In Type I, the malformation is limited to descent of the brainstem and cerebellum into the spinal canal. Other types may be associated with midbrain malformations, aqueductal stenosis, and myelomeningocele.
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