Arnold-Chiari malformation and pregnancy

Chiari (or Arnold-Chiari) malformations are a continuum of abnormalities of the hindbrain with the possibility of disordered cerebrospinal fluid flow and craniospinal pressure gradients. We describe the management of a 30-year-old primigravida who presented following a grand mal seizure during the first trimester. A Chiari type I malformation was diagnosed radiologically. She was delivered at term by elective caesarean section using a general anaesthetic technique. The difficulties in anaesthetising the patient with Chiari malformation are considered, and a literature review is presented to illustrate the risk-benefit analysis undertaken. (C) 2001 Harcourt Publishers Ltd.