Type I Chiari malformation is the mildest form of this disorder. The cerebellar tonsils herniate into the foramen magnum. The prevalence is estimated at 1/1,000. Although often asymptomatic, the condition can be associated with progressive dysfunction of lower cranial nerves, with syringomyelia, or with hydrocephalus. Chiari malformations may also be associated with headaches that are worsened by a Valsalva manoeuvre or postural changes. The treatment is surgical decompression which isn’t warranted if the condition is truly asymptomatic. When I discover a Chiari I in an adult who has no symptoms attributable to it, I follow the patient clinically and, should symptoms develop, re-image the patient.

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