PMC5748138_01
MRI of the brain shows Chiari malformation type 1 with herniation of the cerebellar tonsils beneath the foramen magnum of 17 mm and adenoid hypertrophy.
CRIPE2017-8189790.001.jpg
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fig1
To investigate for an occipital headache, at 3.7 years old, she underwent an MRI that disclosed a CM1 with herniation of the cerebellar tonsils beneath the foramen magnum of 17 mm (Figure 1).
PMC5748138_02
Polysomnography pictures (30 seconds recording) show generalized spike waves during drowsiness (a) and central sleep apneas (3 minutes recording) during the REM stage (b).
CRIPE2017-8189790.002.jpg
PMC5748138_02_CRIPE2017-8189790.002.jpg
fig2
Sleep respiratory parameters were apnea-hypopnea index (AHI) of 9.9 events/hour, of which obstructive sleep apneas (OSA) of 2.7 events/hour, CSA of 4.7 events/hour, greatest duration of 16 seconds (CSA upper normal value for age of 3.2 events/hour), oxygen desaturation index (ODI) of 3.1 events/hour, basal SatO2 of 97%, smallest SatO2 of 85%, snoring of 3% of total sleep time (TST), and periodic limb movement (PLM) index of 2/hour. Sleep stages were REM stage of 20.2%, N1 of 7.2%, N2 of 40%, N3-4 of 32.6%, and arousals in REM stage of 5.4 episodes/hour and in the non-REM stage of 6.8 episodes/hour.  Figure 2 shows hypnagogic paroxysmal spike and wave discharges during drowsiness (a) and central sleep apneas (CSA) during the REM stage (b).