PMC3707328_01
Her left upper limb holding in a peculiar position, with the wrist in extension and the elbow joint in flexion
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F1
On admission, her physical examination revealed spastic paresis of left upper limb, with the limb assuming a peculiar posture at rest, with the wrist in extension and the elbow joint in flexion [Figure 1].
(a) Preoperative sagittal T1-weighted MRI revealing the cerebellar tonsillar herniation of 8 mm. (b) Axial T1-weighted MRI 6 months before the onset and (c) one week after the onset, and (d) sagittal T2-weighted MRI 6 months before the onset and (e) one week after the onset manifesting no progression of cerebellar tonsillar herniation and no syringomyelia
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F2
No recurrence of hydrocephalus was demonstrated [Figure 2a-e]. There was no evidence of syringomyelia or abnormal T2 signal in the spinal cord [Figure 2d and e].
(a) Sagittal fast imaging employing steadystate acquisition (FIESTA) MRI 6 months before the onset and (b) one week after the onset of monoparesis revealed different shapes of tonsils. (c) Axial FIESTA MRI one week after the onset showed the right-sided dominant tonsillar herniation
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F3
Sagittal fast imaging employing steady state acquisition (FIESTA) MRI clearly showed that compared with the previous in detail, the tonsil changed into beaked shape and was asymmetry [Figure 3].
Postoperative sagittal T2-weighted MRI one week after FMD showing the improvement of the cerebellar tonsillar herniation
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F4
Postoperative MRI demonstrated an ascent of the cerebellar tonsil of 4 mm compared with before FMD [Figure 4].