Stepwise Diagnosis of a Chiari Malformation Post-Concussion and Return-to-Play Management in a High School Soccer Athlete

Date

2023

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Martinez, Richard
Bejarano, Michael
Rauf, Ali
Clearfield, Daniel

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Abstract

Background: Limited data exist concerning recommendations on return-to-play for patients with a Chiari I malformation (CIM). A Chiari malformation is a condition involving the brain and spinal cord that results from a structural defect of the occiput. This leads to brain tissue extending through the foramen magnum which can places pressure on the cerebellum and spinal cord leading to neurological manifestations. Much of the symptoms associated with Chiari malformations are present due to the build-up of pressure around surrounding structures. (1)

Case Information: This case study details the management of a 15-year-old female soccer player who was diagnosed with a CIM following a traumatic brain injury (TBI). The patient initially presented to a sports medicine clinic with concussion signs and symptoms that magnified over the course of the first week following the TBI. The patient’s increase in symptom severity combined with behavioral changes prompted further investigation, which led to the detection of a CIM. Her case emphasizes the potential for neurological deficits caused by a head trauma to be complicated by CIM. It likewise illustrates the need to evaluate prolonged concussion symptoms for potential anatomical abnormalities.

In this case report, we follow the patient’s initial diagnosis of concussion and discuss the progression of her symptoms that warranted additional evaluation. We address the neurological workup involved in recognizing how this patient’s presentation suggested a secondary cause for her symptoms. Furthermore, we review relevant literature in reference to current rehabilitative management for CIM.

Conclusions: This case presents a model for how an underlying CIM can exacerbate the development of symptoms acquired through a concussion. It also demonstrates the methods a physician can use in the progression of treatment and tools used to pursue when an initial TBI is not alleviated from conservative therapy or medication. Through this discussion, we provide clinicians with a valuable reference when assessing risk in athletes with CIMs who seek to return to their sport.

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