Klein Robert, Hopewell C Alan, Oien Michael
Carl R. Darnall Army Medical Center (TBI Clinic), 4343 Warm Springs No. 1910, Columbus, GA 31909.
Carl R. Darnall Army Medical Center (TBI Clinic), 36000 Darnall Loop, Fort Hood, TX 76544.
Mil Med. 2014 Jun;179(6):e712-8. doi: 10.7205/MILMED-D-13-00227.
Chiari Malformation type I (CM-I) is a congenital anomaly that occurs when the cerebellar tonsils protrude through the foramen magnum. Individuals with this condition are typically asymptomatic and the identification of the malformation is usually an incidental finding during the course of treating another disorder. This case study explores the neuropsychological sequelae of two unique cases of CM-I in combat veterans. Neuropsychological evaluation revealed that both patients demonstrated preserved general cognitive functioning but had varying patterns of performance on measures of visuospatial, executive functioning, and processing speed. In terms of affective functioning, both endorsed significant depressive symptomatology, but had varying patterns of severity on other estimates of psychiatric symptomatology. Overall, results suggest that there is not one pattern of cognitive and affective functioning associated with CM-I and that environmental and psychological rather than neurological factors should be considered when evaluating cognitive and affective functioning. These cases also highlight the need for neuropsychological evaluation in CM-I in terms of providing guidance for psychoeducation and psychotherapy.
I型Chiari畸形（CM-I）是一种先天性异常，当小脑扁桃体通过枕骨大孔突出时就会发生。患有这种疾病的个体通常没有症状，这种畸形的识别通常是在治疗另一种疾病的过程中偶然发现的。本案例研究探讨了两名退伍军人中CM-I的两个独特病例的神经心理学后遗症。神经心理学评估显示，两名患者的一般认知功能均保持完好，但在视觉空间、执行功能和处理速度测量方面表现出不同的模式。在情感功能方面，两人都认可有明显的抑郁症状，但在其他精神症状评估方面严重程度不同。总体而言，结果表明，与CM-I相关的认知和情感功能模式并非单一，在评估认知和情感功能时应考虑环境和心理因素而非神经因素。这些病例还凸显了对CM-I进行神经心理学评估的必要性，以便为心理教育和心理治疗提供指导。
