Natural history of vocal fold paralysis in Arnold-Chiari malformation

The Chiari I malformation (CM-I) is characterised by overcrowding of the posterior fossa and descent of the cerebellar tonsils and is associated with syringomyelia. With the increasing availability of magnetic resonance imaging, CM-I is placing a growing burden on neurosurgical services. However, its natural history remains poorly understood, and the timing and nature of surgical intervention is controversial. We present a case of a significant, symptomatic CM-I with associated syrinx which underwent complete spontaneous resolution over a 4-year period. Spontaneous regression of Chiari malformation and syringomyelia is exceedingly rare; a literature review reveals 15 other cases and only one case which underwent complete resolution. The present case and literature review suggest a more benign natural history of CM-I and support a more conservative approach to its management. Further studies are required to determine whether any factors can predict resolution for certain patient cohorts.

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The Natural History of Vocal Fold Cysts

The Laryngoscope ◽

10.1002/lary.28377 ◽

2019 ◽

Vol 130 (9) ◽

pp. 2202-2207

Author(s):

Diana N. Kirke ◽

Lucian Sulica

Keyword(s):

Natural History ◽

Vocal Fold ◽

History Of

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Bilateral abductor vocal fold paralysis due to myasthenia gravis

The Journal of Laryngology & Otology ◽

10.1017/s0022215100144834 ◽

1999 ◽

Vol 113 (7) ◽

pp. 678-679 ◽

Cited By ~ 9

Author(s):

Victor Osei-Lah ◽

B. J. O'Reilly ◽

R. Capildeo

Keyword(s):

Myasthenia Gravis ◽

Vocal Fold ◽

Vocal Fold Paralysis ◽

History Of

AbstractWe report a case of bilateral abductor vocal fold paralysis due to myasthenia gravis in a 61-year-old man who presented with stridor requiring tracheostomy. The stridor had been preceded by several weeks' history of diplopia.

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Encysted hydrocele of the canal of Nuck in an 11-month-old child with a past history of duodenal atresia and Arnold-Chiari malformation

Medicine ◽

10.1097/md.0000000000014232 ◽

2019 ◽

Vol 98 (4) ◽

pp. e14232

Author(s):

Zlatan Zvizdic ◽

Emir Milisic ◽

Adisa Chikha ◽

Irmina Sefic ◽

Amra Dzananovic ◽

...

Keyword(s):

Chiari Malformation ◽

Past History ◽

Duodenal Atresia ◽

Arnold Chiari Malformation ◽

Canal Of Nuck ◽

History Of

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Abductor vocal fold palsy as a manifestation of type one Arnold Chiari malformation

The Journal of Laryngology & Otology ◽

10.1258/0022215001905175 ◽

2000 ◽

Vol 114 (3) ◽

pp. 221-223 ◽

Cited By ~ 10

Author(s):

G. M. Allsopp ◽

A. Karkanevatos ◽

R. C. Bickerton

Keyword(s):

Aspiration Pneumonia ◽

Chiari Malformation ◽

Vocal Fold ◽

Rare Case ◽

Arnold Chiari Malformation ◽

Vocal Fold Palsy ◽

Laryngeal Sensation ◽

Chiari Malformations

We report a rare case of type 1 Chiari malformation which presented to the Otolaryngology department with abductor vocal fold palsy following an aspiration pneumonia secondary to absent laryngeal sensation. Chiari malformations and related cases are discussed.

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Hoarseness due to Mycobacterium kansasii

The Journal of Laryngology & Otology ◽

10.1017/s0022215108003393 ◽

2008 ◽

Vol 123 (5) ◽

pp. 569-571 ◽

Cited By ~ 2

Author(s):

D Wray ◽

M O Oko ◽

D A R Boldy ◽

M T Butt

Keyword(s):

Weight Loss ◽

World Literature ◽

Vocal Fold ◽

Sputum Sample ◽

Vocal Folds ◽

Vocal Fold Paralysis ◽

Mycobacterium Kansasii ◽

Unilateral Vocal Fold Paralysis ◽

Abnormal Chest ◽

History Of

AbstractObjective:To present a case of unilateral vocal fold paralysis due to Mycobacterium kansasii induced pressure on the left recurrent laryngeal nerve, a specific aetiology not previously reported in the world literature.Case report:A 57-year-old Caucasian man presented with a short history of productive cough, fever, hoarseness and 14-kg weight loss. He was a smoker, had an abnormal chest X-ray and was human immunodeficiency virus negative. A sputum sample was positive on direct microscopy for acid fast bacilli. Initially, the patient was treated with Rifater (rifampicin, isoniazid and pyrazinamide) and ethambutol. Mycobacterium kansasii was isolated and proved sensitive to this antimycobacterial treatment. Nasoendoscopy revealed diminished movement of the left vocal fold, and a computed tomography scan showed enlarged mediastinal lymph nodes anterior to the aortic arch. After three months of antimycobacterial treatment, the vocal folds were fully mobile at repeat nasoendoscopy, and this coincided with gradual resolution of the patient's hoarseness and weight loss.Conclusions:There are many causes of unilateral vocal fold paralysis. This case illustrates the importance of anatomical knowledge in reaching a diagnosis, and also presents the first reported case of Mycobacterium kansasii creating this clinical picture.

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Breaking Barriers for Cerebrospinal Fluid Flow in Chiari Malformation Type I: “What and How Much Is Enough?” A Retrospective Analysis of 74 Cases

Indian Journal of Neurosurgery ◽

10.1055/s-0038-1676664 ◽

2018 ◽

Vol 07 (03) ◽

pp. 196-208

Author(s):

Manish Jaiswal ◽

Amit Patil ◽

Radhey Mittal

Keyword(s):

Cerebrospinal Fluid ◽

Natural History ◽

Retrospective Analysis ◽

Chiari Malformation ◽

Foramen Magnum ◽

Common Finding ◽

Type I ◽

Chiari Malformation Type I ◽

Compression Syndrome ◽

History Of

Abstract Introduction: Chiari malformation type I is a collection of hindbrain abnormalities, for which natural history of the disease process is not clear. The challenge is to identify which patients will benefit most from posterior fossa decompression. Objectives: To identify important surgical implications that most likely benefit patients with Chiari malformation type I by analyzing and reviewing various operative interventions in these patients with appropriate symptoms and then following their course. Subjects & Methods: Retrospective analysis of 74 operated Chiari malformation type I with syrinx adult patients was done. Results: No definite pattern of progression in natural history of disease was noted. Most of the patients who were symptomatically stable for months to years presented with recent rapid progression. The most common symptom was suboccipital pain. The most common finding was lower extremity weakness. On clinical presentation basis, patients were divided into three categories: foramen magnum compression syndrome, central cord syndrome, and cerebellar syndrome. Most patients in our study fall in first category. Foramen magnum decompression with atlas posterior arch removal and sometimes partial C2 laminectomy depending on extent of tonsillar descent as well as augmentation duraplasty was done in most patients. Improvement was seen in foramen magnum compression syndrome group more significantly. Conclusions: Individualized surgical techniques for breaking the barriers of cerebrospinal fluid (CSF) flow in Chiari malformation type I with syrinx to restore normal CSF dynamics across craniocervical junction provide the pragmatic solution. The trend is toward balance between optimum wide decompression as compared with long craniocaudal decompression and preserving normal integrity.

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