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A 33 year-old man presented with vertical nystagmus. Otherwise, his examination was normal.
(Left) Sagittal T2-weighted image of the spine; (Right) Axial T2-weighted axial image of the spine. Note in the Chiari malformation that the brainstem and cerebellar tonsils descend below the foramen magnum . In addition, there is a large syrinx (yellow arrow) in the cervical cord. On the axial scan, note how large the syrinx is compared to the spinal cord. 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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