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Objective Broader access to magnetic resonance imaging (MRI) has increased the diagnosis of tonsillar ectopia, with most of these patients being asymptomatic. The early diagnosis and treatment of type I Chiari malformation (CM I) patients has impact on the prognosis. This study supplements information about the neurologic exam of symptomatic patients with CM I. Methods The sample was composed of 32 symptomatic patients with CM I diagnosed by a combination of tonsil herniation of more than 5 mm below the magnum foramen (observed in the sagittal T2 MRI) and at least one of the following alterations: intractable occipital headache, ataxia, upper or lower motor neuron impairment, sensitivity deficits (superficial and deep) or lower cranial nerves disorders. Results Occipital headache was the most frequent symptom (53.12%). During the physical exam, the most common dysfunctions were those from the pyramidal system (96.87%), followed by posterior cord syndrome (87.5%). Discussion In this study, patients became symptomatic around the fifth decade of life, which is compatible with previous descriptions. Patients with more than 2 years of evolution have worse responses to treatment. Occipital headache, symptoms in the upper limbs, gait and proprioceptive disorders are common findings in patients with CM I. Conclusion Deep tendinous reflexes and proprioception disorders were the main neurologic features found in symptomatic CM I patients.

Introduction With the advancement of clinical and surgical oncology, patients with breast cancer had an increase in survival. In this context, up to 30% of patients affected with metastases from this site will develop brain tumors. The latter is an important impacting factor for life quality and expectancy, therefore, it’s clinical and surgical management is essential in public health. We present some rare cases and their outcomes. Methods We describe a case series of 07 patients with breast cancer metastases to the brain, involving large portions of the dura, bone or skin. There were 64 surgical interventions of the disease in the period, but only those with more exuberant and atypical presentations were selected. The interventions were carried out in a hospital oncology complex in northeastern Brazil between 2016 and 2020.The diagnosis was based on the clinical description, laboratory and image exams, histopathology and surgical performance of the patients. Results The mean age of the patients was 49.7 years, with all patients being female. Rare presentations were observed, such as bone and skin meninges. Clinical presentations demonstrated advanced stages of the disease with a large tumor volume. Extra axial involvement was verified. All patients underwent neurosurgery for tumor removal and decompression. Biopsies were submitted to anatomopathological and immunohistochemistry examination. Corticotherapy was instituted in the immediate postoperative period and some cases had genetic analysis due to an important family history. There was a reduction in symptoms in most cases. Conclusion Although brain metastases are still a challenge for medical practice, their proper management can prolong and improve patients’ lives. Metastatic breast cancers seem to have a predilection for the central nervous system and their detection and intervention, even in an advanced clinical stage, sound as determinant for the control and severity of symptoms. Keywords Brain Neoplasms, Neoplasm Metastasis, Breast Neoplasms

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