Precocious puberty and Chiari I malformation with syrinx: a case report of an unusual presentation of Costello syndrome.

Although recent publications do not recommend routine brain MRI in girls with isolated CPP over 6 years of age, in those with CS actionable MRI findings are more likely and imaging should be performed. It is unclear whether the cerebral malformation in the patient contributed to CPP or was an incidental syndromic finding.