A Child with Recurrent Vomiting and Short Neck

Excerpt

To the Editor: An eight-year-old boy presented with multiple episodes of vomiting and dizziness for 7 d. He had a history of similar episodes of recurrent vomiting for the last four years. Vomiting would occur 15–20 times per day, containing ingested food and water. These episodes used to occur every 3–4 mo, and each episode lasted for 3–4 d. The child was asymptomatic in between these episodes. On examination, his weight and height suggested acute on chronic malnutrition and head circumference was normal. His neck length was 9.5 cm (normal range 13.87–14.01 cm) (Supplementary Fig. 1A), and neck body ratio was 8.19 (normal range 12.53–12.88) [1]. Systemic examination was normal. Ultrasonography of the abdomen, liver and renal function test, serum amylase and lipase and upper gastrointestinal endoscopy were unremarkable. X-ray neck showed block C1–2 and C3–4 vertebra (Supplementary Fig. 1B). Magnetic resonance imaging (MRI) of the brain and spine showed Chiari 1 malformation with tonsillar herniation of 5.2 mm (Supplementary Fig. 1C). …