Because stumbling upon such unexpected findings - especially ones of unclear clinical importance - can lead to more, often unnecessary, tests and fear, the Hopkins study highlights the need for pediatricians to prepare for such discussions, Strouse says. And in the absence of guidelines on how to deal with such findings, many pediatricians, Strouse adds, feel so unprepared that they may forego the discussion altogether and simply refer the patient to a neurologist or a neurosurgeon for consultation.

"Helpful as it is, imaging technology can open a Pandora's box, sometimes showing us things we didn't expect to see and are not sure how to interpret," says lead investigator Lori Jordan, M.D., Ph.D., a pediatric neurologist at Hopkins Children's.

Twenty-five children (2.6 percent) required only routine follow-up for spinal cord anomalies or another, less serious subtype of Chiari malformation with minimal brain tissue protrusion into the spinal canal. Thirty-two children (3.4 percent) required no follow-up at all for a benign anatomical anomaly called cavum septum pellucidum, marked by the presence of a thin membrane separating the lateral ventricles of the brain, which along with Chari malformation were the most common anomalies in the study. Other abnormalities included brain cysts and cortical dysplasia, a condition in which certain nerve cells form abnormally in the wrong part of the brain and can lead to seizures.

Source: Johns Hopkins Medical Institutions