Revista de Medicina Desportiva (English) September 2018 | Page 22

Rev. Med. Desp. informa, 2018; 9(5):20–21.
Chiari Malformation and
Sports Practice
Dr. João P. Pinheiro 1 , Prof. Doctor João Páscoa Pinheiro 2 , Prof. Doctor Armando Rocha 3 , Prof. Doctor
Marcos Barbosa 4
1
Resident on neurosurgery; 2 Physicoian. Physical medicine and rehabilitation, Sports medicine; 3 Senior
Hospital assistant of neurosurgery; 4 CHUC Neurosurgery Service Director. Coimbra, Portugal
ABSTRACT
The diagnosis of Chiari malformation type 1 (CH1) is usually based on imaging characteristics
observed on computed tomography (CT) or magnetic resonance imaging (MRI). The greater acces-
sibility to these tests makes the diagnosis of MC1 more common. MC1 is a rare clinical entity in
sports. The diagnosis in athletes should motivate their referral to a neurosurgical department. The
morphological changes of MC1 predispose athletes, especially in contact sports, to an increased risk
of neurological damage or even sudden death. We also referred to the importance of the diagnosis
of MC1, valuing some clinical aspects in the sports-medical examination, such as mechanical neck
pain, headache or unexplained dysesthesias and paresthesias.
PALAVRAS-CHAVE / KEYWORDS
Chiari malformation 1, sports
Introduction
The Chiari Type 1 (MM1) is an
uncommon clinical entity in
the population and very rarely
approached in the sport con-
text. This malformation carries
an increased risk of neurological
pathology or even sudden death,
particularly in contact sports (CS). 1
This diagnosis conditions and
restricts some gestures and modali-
ties in order to protect the athlete.
Some symptoms and signs should
be considered, particularly in the
context of the sports-medical exami-
nation.
In the CM1 the posterior fossa has
a smaller volume than the normal.
The decrease of the physical space
promotes caudal displacement to
the cervical canal of the cerebellar
tonsils. Relative to the level of the
foramen magnum, the amygdalin her-
niation is five or more millimeters. 3
The alteration of the normal flow of
the cerebrospinal fluid may be asso-
ciated with syringomyelia, observed
in 30-70% of patients with CM1, and
to an increased risk of cerebral con-
cussion due to decreased damping
capacity of the cerebral parenchyma
after a cranioencephalic trauma
(CET). 4,5
Most carriers of CM1 are asymp-
tomatic. The most common symp-
tom is the occipital headache (65%),
usually associated with cervical
pain. The cervical extension and
the Valsalva maneuver exacerbate
the pain. Also, neurological signs
and symptoms associated with the
compression of the cerebellum and
of the bulbous, such as ataxia, nys-
tagmus and decreased gag reflex may
be present. 3
The syringomyelia may be asymp-
tomatic or be associated with signs
of injury of the first neuron, such as
tetraparesis predominating distally,
hyper reflex and sensitivity dissocia-
tion syndrome. 6
Sports Practice and Chiari 1
The restrictions of the athletes with
CM1 to practice contact sports have
been the subject of discussion and
controversy, given the absence of
guidelines. After a CET or a cervical
trauma, the likelihood of bulbous or
medullary contusion is higher in the
athlete with MC1, where the risk of
severe neurological lesions or sud-
den death is increased. 7
There are two dozen of cases of
subjects diagnosed with CM1 that
suffered TCE or cervical trauma
during sporting practice or in
similar situations. In 1995 James DS
described the case of a 25-year-old
male fight sportsman. After a coup,
he suddenly died with cardiorespi-
ratory arrest. The autopsy revealed
CM1 associated with syringomyelia
from C1 to C7. 8 In 1998 and 2013,
two cases of sudden death were
What is Chiari type 1?
Chiari’s malformations were
described in 1890 by the anatomist
Dr. Hans Chiari, they include a set
of hindbrain anomalies, ranging
from a simple herniation of cerebel-
lar tonsils to a complete agenesis
of the cerebellum (figure 1 and 2).
Four types of malformations are
described in the literature. The
malformations of Chiari II, III and IV
are rare. 2
20 september 2018 www.revdesportiva.pt
Figure 1 – Chiari
https://uprightdoctor.wordpress.com/2011/01/16/
chiari-malformations-and-cranial-nerves/
Figure 2 – Chiari malformation with
syringomyelia
https://radiopaedia.org/play/1802/entry/24190/
case/15819/studies/15469