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I Was the Clumsy One

Exploring the Central Nervous System through Type I Chiari Malformation


Philomena M. Behmer
Department of Science and Humanities
Pennsylvania College of Health Sciences
Stacy A. Ropp
Pennsylvania College of Health Sciences
Angela Z. Shertzer
Center for Teaching and Learning
Pennsylvania College of Health Sciences


This interrupted case study explores the central nervous system (CNS) by comparing normal CNS anatomy and physiology to the true story of a woman with type I Chiari malformation (CM). Type I CM is a condition involving anatomical anomalies of the hindbrain that may cause the protrusion of cerebellar tissue into the spinal cavity. These defects can compromise brain and cranial nerve function and disrupt the normal flow of cerebral spinal fluid (CSF). Stacy Ropp, a patient with type I CM, narrates her experience with this condition in four parts. In Part I, she discusses her signs, symptoms, and initial diagnosis; in Part II, she explains her initial treatment; in Part III, she reveals recurring symptoms, and in Part IV, she shares how a second opinion results in a more successful treatment of her condition. Specific concepts addressed in the case study include skull and vertebral bones associated with the CNS, CSF flow, neural reflexes, neural pathways, and cranial nerves. The case is appropriate for use in a variety of human biology courses with an emphasis on anatomy and physiology, neuroscience, pathophysiology, or radiography.


  • List the components and functions of the central nervous system and major brain regions.
  • Describe type I CM skeletal anomalies and relate them to the signs and symptoms of type I CM.
  • Identify the steps of a neural reflex and explain abnormal reflexes associated with type I CM.
  • List the layers of CNS meninges, describe cerebrospinal fluid (CSF), and explain the impact of CSF flow interruption in type I CM.


Chiari; Chiari malformation; CM; central nervous system; CNS; cerebral spinal fluid; CSF; skull anatomy; vertebral anatomy; neural reflexes; cranial nerves; neural pathways

Topical Areas


Educational Level

Undergraduate lower division



Type / Methods

Directed, Interrupted



Subject Headings

Anatomy  |   Physiology  |   Medicine (General)  |   Neuroscience  |  

Date Posted


Teaching Notes

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The following video(s) are recommended for use in association with this case study.

  • I Was the Clumsy One
    This video features Dr. Max Lowden, a neurologist employed at Penn State Medical Center, and Stacy Ropp, a patient with Chiari malformation. Dr. Lowden explains the anatomy and physiology of Chiari Malformation and Stacy shares what it is like to live with this condition. Running time: 10:38 min. Produced by P. Behmer, S. Ropp, and A. Shertzer, 2019.