• Christopher Elia, James Brazdzionis, and Vartan Tashjian.
• Riverside University Health System Medical Center-Division of Neurosurgery, Moreno Valley, California, USA; Department of Neurosurgery, Kaiser Permanente Fontana Medical Center, Fontana, California, USA. Electronic address: eliachr1@gmail.com.
• World Neurosurg. 2018 Mar 1; 111: 154-156.

IntroductionChiari malformation (CM) type I commonly presents with symptoms such as tussive headaches, paresthesias, and, in severe cases, corticobulbar dysfunction. However, patients may present with atypical symptoms lending to the complexity in this patient population. We present a case of a CM patient presenting with atypical cardiac symptoms and arrhythmias, all of which resolved after surgical decompression.Case DescriptionA 31-year-old female presented with atypical chest pain, palpitations, tachycardia, headaches, and dizziness for 2 years. Multiple antiarrhythmics and ultimately cardiac ablation procedure proved to be ineffective. Magnetic resonance imaging revealed CM, and the patient ultimately underwent surgical decompression with subsequent resolution of her symptoms.ConclusionThe surgical management of CM patients presenting with atypical symptoms can be challenging and often lead to delays in intervention. To our knowledge this is the only reported case of a patient presenting with tachyarrhythmia and atypical chest pain with resolution after Chiari decompression. We believe the dramatic improvement documented in the present case should serve to advance Chiari decompression in CM patients presenting with refractory tachyarrhythmia in whom no other discernable cause has been elucidated. Further studies are needed to better correlate the findings and to hopefully establish a criteria for patients that will likely benefit from surgical decompression.Copyright © 2017 Elsevier Inc. All rights reserved.

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