Evaluation and management of the Chiari malformation type 1 for the primary care pediatrician.

Diagnosis and treatment of CMI is undergoing reexamination that includes redefinition of the anatomic Chiari malformation and refinement and redefinition of the clinical syndrome. Children with SMI present with head pain of some kind, a neurologic deficit, or with signs of spinal cord dysfunction from syrinx. Some will present with no clinical syndrome at all. Presence of anatomic Chiari malformation or compelling clinical Chiari syndrome should lead to evaluation by a neurologist or neurosurgeon experienced with the syndromes and their treatment. Treatment options are varied but usually result in resolution of symptoms. When symptoms persist after surgery, management is complex and not uniformly successful, even in the most experienced hands.