Cerebellar Tuberculoma in a HIV Coinfected Patient with Arnold-Chiari I Malformation

Article Information

Article Type: Research Article

Citation: Benabdellah A, Bachir N, Belharane A, Benabadji A, Benchouk S, et al. (2015) Cerebellar Tuberculoma in a HIV Coinfected Patient with Arnold-Chiari I Malformation. J HIV AIDS 1 (1): doi http://dx.doi.org/10.16966/jha.104

Copyright: © 2015 Benabdellah A, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

Publication history: 

 Received date: 18 May 2015

 Accepted date: 04 June 2015

 Published date: 10 June 2015

Authors :
Benabdellah A¹      Bachir N²      Belharane A²      Benabadji A²      Benchouk S²       Bensaha Z²      Bensaad M²      Brahimi H²      Lakhdori F²      Mahamdaoui F²      Mahmoudi R²      Taleb-Bendiab R²      Allal-Taouli K²      Labdouni MH²      Bensenane M³      Berrada S^3 
1HIV laboratory research, University of Oran, Algeria ²CHU TLEMCEN, University of Oran, Algeria³CHU ORAN, University of Oran, Algeria
*Corresponding author: Benabdellah Anwar, HIV laboratory research, University of Oran, BP 1524 ELM_Naouer 31000 Oran, Algeria, Tel: +213 (0) 41 58 19 47 /+213 (0) 41 58 19 41; E-mail: benabdellah.anouar@univ-oran.dz
Abstract

The four types of Chiari malformations, as described by Dr. Hans Chiari, have neither anatomic nor embryologic correlation. Their only commonality is that they all involve the cerebellum. Chiari I malformation consists of herniation of the cerebellar tonsils into the foramen magnum, thus crowding the craniocervical junction. Chiari II malformation is almost exclusively associated with myelomeningocele and hydrocephalus. It consists of herniation of not only the tonsils but also all the contents of the posterior fossa into the foramen magnum. This herniation involves the brainstem, fourth ventricle, and cerebellar vermis. Chiari III and IV malformations are rare. Chiari III represents an encephalocele (external sac containing brainstem and posterior fossa contents); thus, the cerebellum and brainstem are descending not only into the spine, but also into an external sac. Chiari IV consists of cerebellar hypoplasia. The Chiari I malformation has the latest mean age of clinical presentation. A Chiari type I anomaly presenting in adulthood is the focus of this case report. Surgery is indicated with neurological dysfunction, symptomatic syrinx, or hydrocephalus. Of all Chiari I patients, 15% - 20% will have hydrocephalus. For some of them, the hydrocephalus will resolve with ventriculoperitoneal shunting, alleviating the need for a Chiari decompression. Long-term prognosis for patients with symptomatic Chiari type I malformations who undergo surgical treatment is variable, based on the patients presenting symptoms and spinal cord cyst response.

Keywords
Cerebellar tuberculoma; Arnold-Chiari malformation; HIV infection

Figure 1: Brain magnetic resonance imaging. A hypointense signalmass in the left hemisphere of the cerebellum corresponding to asous-cortical postero-paramedian abscess measuring 13 mm showing unique ringenhancing lesion, surrounded by edema.


Figure 2:MRI of the head and spine (T2 weighted sagittal view) at time of presentation revealed a T1 hyposignal and hypersignal T2 lesion measuring 13 mm with annular enhancement corresponding to a souscortical postero-median abscess as well as an Arnold-Chiari type 1 malformation with effacement of the citern of posterior fossa and tonsillar herniation in the magnum over 05 mm descending to C2.

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