Acute esotropia left. Orbits: There is no evidence of intraorbital mass lesions. The extraocular muscles are intact bilaterally, without evidence of deformity or atrophy. The globes, lacrimal glands, orbital fat, and optic nerves are unremarkable bilaterally. The orbital walls appear to be intact.Brain: The cerebellar tonsils display a pointed morphology and are low-lying, extending up to approximately 8 mm inferior to the foramen magnum. In addition, the posterior fossa capacity is relatively small and there is crowding of the foramen magnum contents. There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a small developmental venous anomaly in the right medial orbitofrontal gyrus. The brain parenchyma otherwise appears unremarkable. The cavernous sinuses appear to be intact. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. There is minimal scattered paranasal sinus mucosal thickening and right mastoid air cell fluid.
1. Findings indicative of Chiari type 1 malformation, which can potentially be associated with acquired esotropia. 2. No evidence of intraorbital lesions or gross extraocular muscle abnormalities.3. No evidence of intracranial tumors or acute infarction.REFERENCES:1. Lewis AR, Kline LB, Sharpe JA. Acquired esotropia due to Arnold-Chiari I malformation. J Neuroophthalmol. 1996 Mar;16(1):49-54.2. Bixenman WW, Laguna JF. Acquired esotropia as initial manifestation of Arnold-Chiari malformation. J Pediatr Ophthalmol Strabismus. 1987 Mar-Apr;24(2):83-6.3. Biousse V, Newman NJ, Petermann SH, Lambert SR. Isolated comitant esotropia and Chiari I malformation. Am J Ophthalmol. 2000 Aug;130(2):216-20.Discussed with Dr. Folk at 8:40 AM on 1/29/16.