Arnold Chiari Malformation / Parkinson's Disease

Clinical Signs: downward jerking of eyes every 1-2 sec; nystagmus. 12-14-82: 50 yr. old woman who has been followed with a Dx of Parkinson's for 9 years with presenting Sx of progressive (?) stiffness of legs but not of arms. The conspicuous eye signs are down-beat nystagmus and poor pursuit and poor vestibular suppression. Of interest, however, is patient's history of episodic dizzy spells dryness of mouth, swallowing difficulties, precipitated by coughing or sneezing. These last only 1-2 minutes and are not associated with postural changes nor followed by h.a. These have been called spells and treated (unsuccessfully) by dilantin but were never accompanied by unconsciousness. During the spell she knew what people were saying to her but would be unable to reply. Nor could she open her eyes during an episode. These spells used to occur at irregular intervals, perhaps several times a day but have not occurred during the past two years. Pt. also gives a history of relative anesthesia of arms and legs. Drops hot material on her skin without feeling it. Impression: Possible Arnold- Chiari or syrinx. Rx: to have metrazanide study. 6-29-83 Had suboccipital craniectomy 6 weeks ago with release of adhesions and exposure of tonsils. Was immediately relieved of pins and needles sensation and disappearance of slurring of speech; also walked better. Oscillopsia upgaze but exaggerated on blink downgaze and gaze to either side. Vestibular suppress poor. Pathology: Lesions of posterior cranial fossa. Disease/ Diagnosis: Posterior Fossa Lesions; oscillopsia; vertical nystagmus.