PMC5792821_01
Longitudinal growth curves and growth velocity in the patient (a 12-yr-old boy).
Closed circles indicate height and open circles indicate height velocities. The
arrowhead indicates the time when GH therapy was initiated.
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He demonstrated delayed growth since early childhood, his height was 89.9 cm [-1.0 standard deviation (SD)] at the age of 3 yr, 107.7 cm (-1.4 SD) at the age of 6 yr, and 127.0 cm (-1.8 SD) at the age of 10 yr and 4 mo (Fig. 1).
(a) Sagittal T1-weighted magnetic resonance imaging (MRI) prior to GH therapy showing
no abnormalities. (b) Sagittal T1-weighted MRI after GH therapy showing herniation of
the cerebellar tonsils 15 mm below the foramen magnum (black line) into the cervical
spinal cord.
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T1-weighted images observed on magnetic resonance imaging (MRI) prior to administration of GH therapy revealed no abnormalities (Fig. 2-a). A sagittal T1-weighted MRI scan demonstrated herniation of the cerebellar tonsils 15 mm into the cervical spinal cord below the foramen magnum (Fig. 2-b, Fig. 3-a).
(a) Coronal T1-weighted magnetic resonance imaging (MRI) prior to surgery showing
herniation of the cerebellar tonsils 15 mm below the foramen magnum (black line) into
the cervical spinal cord. (b) Sagittal T1-weighted MRI of the entire spinal cord does
not show syringomyelia.
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An MRI of the entire spinal cord revealed no abnormalities, including syringomyelia and/or a tethered cord (Fig. 3-b).
(a) Sagittal T1-weighted magnetic resonance imaging (MRI) prior to surgery showing
herniation of the cerebellar tonsils 15 mm below the foramen magnum (black line) into
the cervical spinal cord. (b) Sagittal T1-weighted MRI a week after surgery showing
slight improvement in the Chiari type 1 malformation. (c) Sagittal T1- weighted MRI
performed 6 mo after surgery showing marked improvement in the Chiari type 1
malformation.
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AHI 2-4. An MRI obtained 6 months postoperatively demonstrated improvement in the Chiari type 1 malformation (Fig. 4).