A 65 year old lady came to clinic complaining of severe headache for 5 years, triggered by cough, in the occipital region. She is suffering from bronchial asthma for 7 years, using ventulin inhaler, phyllocort  225 mg twice daily, simvor 20 mg once daily, juspirin 81 mg once daily and diamox once daily.

MRI of the brain done 23-09-2004 demonstrating Arnold-Chiari malformation second degree  with tonsilar herniation reaching the third cervical vertebra. On examination, the patient was unable to walk or stand without aid and Romberg test showed fall to all directions, more prominent forward. She has swallowing difficulty for 5 years. Rt upper and lower extremities weakness was noted and hypalgesia below C2 right side.

The patient was operated 06-10-2004. Through midline posterior occipital approach drilling of the posterior half of foramen magnum with laminectomy C and partially of C2 was performed and all the constricting bands were removed. Despite that the dura itself was also constricting the area, especially at the foramen magnum level. Longitudinal incision was performed and lyodura was used to widen the constricting part.

The patient was re-examined 31-10-2004 : She can walk without aid and all the cerebellar signs disappeared . Swallowing became better and the power right extremities normalized. The sensory deficit was localized only to the right hand.