scholarly journals Pyramidal and Proprioceptive Dysfunctions as the Main Neurologic Features In Symptomatic Type I Chiari Malformation Patients

2018 ◽  
Vol 37 (03) ◽  
pp. 258-262
Author(s):  
Bruno Leimig ◽  
Claudio Vidal ◽  
Marcelo Valença ◽  
Joacil Silva ◽  
Walter Matias Filho
Keyword(s):  
Chiari Malformation ◽  
Cranial Nerves ◽  
Type I ◽  
Upper Limbs ◽  
Resonance Imaging ◽  
Tonsillar Ectopia ◽  
Occipital Headache ◽  
Magnetic Resonance Imaging Mri ◽  
Lower Cranial Nerves ◽  
T2 Mri

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.

Primary brain stem tethering: a rare cause of geniculate neuralgia

1999 ◽  
Vol 113 (10) ◽  
pp. 945-947 ◽  
Author(s):  
Geert G. Buyse ◽  
Jo Caekebeke ◽  
Philippe Demaerel ◽  
Chris Plets
Keyword(s):  
Brain Stem ◽  
Unusual Case ◽  
Cranial Nerves ◽  
Resonance Imaging ◽  
Considerable Decrease ◽  
Magnetic Resonance Imaging Mri ◽  
Fitting In ◽  
Lower Cranial Nerves ◽  
The Brain ◽  
Subcutaneous Lipoma

AbstractThis rare case of brain stem tethering presented with chronic and progressive geniculate neuralgia. In view of the fact that an occipital subcutaneous lipoma had been resected in childhood, it probably concerned a primary tethering, fitting in with an occult occipital dysraphism.Magnetic resonance imaging (MRI) clearly demonstrated an underlying tethering, causing a distortion of the brain stem. Consequently, this led to the hypothesis that the geniculate neuralgia could be explained by traction on the lower cranial nerves secondary to the brain stem displacement. Untethering resulted in a considerable decrease of the neuralgia.MRI proved to be essential in the diagnosis and treatment of this unusual case.

Foramen Magnum Meningioma Presenting with Cough Syncope (Case Report and Review of the Literature)

2018 ◽  
Vol 37 (04) ◽  
pp. 334-338
Author(s):  
Metin Kaplan ◽  
Omer Hepgunsel ◽  
Selman Kok ◽  
Murat Gonen
Keyword(s):  
Cranial Nerves ◽  
Contralateral Side ◽  
Foramen Magnum ◽  
Posterolateral Approach ◽  
Resonance Imaging ◽  
Vertebral Arteries ◽  
Neural Axis ◽  
C2 Vertebra ◽  
Magnetic Resonance Imaging Mri ◽  
Lower Cranial Nerves

AbstractForamen magnum meningiomas cause different symptoms based on the size and the location of the tumor. They often present with involvement of the long tracts and of the lower cranial nerves. Ataxia and occipitocervical headache are other common symptoms. In the present study, we report a case of foramen magnum meningioma presenting with cough syncope. A mass lesion located anterolateral to the foramen magnum was detected in a 38-year-old man during a magnetic resonance imaging (MRI) exam; the lesion extended from the inferior clivus to the level of the C2 vertebra. The neural axis has pushed towards posterior and contralateral side by the mass. We think that syncope occurred due to the encasement of the vertebral arteries by the tumor in addition to the compression of the neural axis. The posterolateral approach without condylar resection provides a safe surgical plane for total excision of these tumors. In our case, the tumor was totally removed and the syncope episodes were resolved.

scholarly journals Epidemiology of Symptomatic Chiari Malformation in Tatarstan: Regional and Ethnic Differences in Prevalence

Neurosurgery ◽  
2018 ◽  
Vol 84 (5) ◽  
pp. 1090-1097 ◽  
Author(s):  
Enver I Bogdanov ◽  
Aisylu T Faizutdinova ◽  
Elena G Mendelevich ◽  
Alexey S Sozinov ◽  
John D Heiss
Keyword(s):  
Ethnic Differences ◽  
Chiari Malformation ◽  
Health Impact ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Tonsillar Ectopia ◽  
Group A ◽  
The Republic ◽  
Magnetic Resonance Imaging Mri ◽  
Regional Disease

AbstractBACKGROUNDEpidemiology can assess the effect of Chiari I malformation (CM1) on the neurological health of a population and evaluate factors influencing CM1 development.OBJECTIVETo analyze the regional and ethnic differences in the prevalence of CM1.METHODSThe population of the Republic of Tatarstan (RT) in the Russian Federation was evaluated for patients with CM1 symptoms over an 11-yr period. Typical symptoms of CM1 were found in 868 patients. Data from neurological examination and magnetic resonance imaging (MRI) measurement of posterior cranial fossa structures were analyzed.RESULTSMRI evidence of CM1, defined as cerebellar tonsils lying at least 5 mm inferior to the foramen magnum, was found in 67% of symptomatic patients. Another 33% of symptomatic patients had 2 to 4 mm of tonsillar ectopia, which we defined as “borderline Chiari malformation type 1 (bCM1).” The period prevalence in the entire RT for symptomatic CM1 was 20:100 000; for bCM1 was 10:100 000; and for CM1 and bCM1 together was 30:100 000. Prevalence of patients with CM1 symptoms was greater in the northern than southern districts of Tatarstan, due to a high prevalence (413:100 000) of CM1 in the Baltasy region in one of the northern districts.CONCLUSIONOne-third of patients with typical symptoms of CM1 had less than 5 mm of tonsillar ectopia (bCM1). Assessments of the health impact of CM1-type symptoms on a patient population should include the bCM1 patient group. A regional disease cluster of patients with Chiari malformation was found in Baltasy district of RT and needs further study.

scholarly journals Internal Auditory Canal Reconstruction After Vestibular Schwannomas Removal Through Retrosigmoid-Transmeatal Approach

2018 ◽  
Vol 26 (3) ◽  
pp. 237-241
Author(s):  
Ricardo Ramina ◽  
Gustavo Simiano Jung ◽  
Erasmo Barros Da Silva Jr ◽  
Guilherme José Agnoletto ◽  
Luis Fernando Moura Da Silva Jr ◽  
...  
Keyword(s):  
Cranial Nerves ◽  
Internal Auditory Canal ◽  
Jugular Foramen ◽  
Vestibular Schwannomas ◽  
Fat Tissue ◽  
Resonance Imaging ◽  
Tumor Removal ◽  
Postoperative Mri ◽  
Csf Leakage ◽  
Magnetic Resonance Imaging Mri

Objectives: To present a technique of internal auditory canal (IAC) reconstruction using a pediculated dural flap, after removal of vestibular schwannomas through the retrosigmoid craniotomy. Methods: From a series of 213 patients with vestibular schwannomas operated between January 2008 and March 2016 through the retrosigmoid-transmeatal approach, 183 underwent reconstruction of the internal auditory canal with a pediculated dural flap. The IAC was drilled towards the fundus preserving the labyrinthine structures. The dura mater over the IAC was dissected from the bone, remaining pediculated at the entrance of the jugular foramen. This dural flap was used to cover the cranial nerves inside the IAC after tumor removal. Opened mastoid cells and the IAC were closed with muscle or fat grafts and fibrin glue. Results: Reconstruction of the IAC using the described technique was possible in in 183 cases. Fifteen patients (6.8%) developed postoperative cerebrospinal fluid (CSF) leakage and seven patients required reoperation (3.2%) to close the fistulae. Postoperative magnetic resonance imaging (MRI) examinations showed the presence of CSF within the IAC around the preserved cranial nerves. Conclusions: This technique of IAC reconstruction after surgical resection of vestibular schwannomas may avoid scar and adhesion of muscle or fat tissue with preserved cranial nerves, allowing CSF enter inside the IAC. It may help to identify tumor remnants and/or recurrences in postoperative MRI examinations. Comparative studies are needed to evaluate if this technique improves postoperative hearing and facial nerve outcomes.

Orbitomeningeal Band in Transcavernous Dissection and Anterior Clinoidectomy: 3-Dimensional Operative Video

2020 ◽  
Vol 19 (4) ◽  
pp. E414-E414
Author(s):  
Alvaro Campero ◽  
Matias Baldoncini ◽  
Juan F Villalonga ◽  
Amparo Sáenz
Keyword(s):  
Skull Base ◽  
Cranial Nerves ◽  
Lateral Wall ◽  
Senior Author ◽  
Microsurgical Anatomy ◽  
Resonance Imaging ◽  
Superior Orbital Fissure ◽  
3 Dimensional ◽  
Magnetic Resonance Imaging Mri ◽  
Base Lesion

Abstract The orbitomeningeal or meningo-orbital band (MOB) has been described as the most superficial dural band responsible for tethering the frontotemporal basal dura to the periorbita.1,2 The MBO usually interferes with the surgical approach to the most profound areas of the anterior and middle skull base. It is known that there are no cranial nerves on the lateral surface of the superior orbital fissure; therefore, the neurosurgeon can cut the MOB without causing any neurological deficit and, at the same time, achieving fully exposure of the anterior clinoid process1-4 and/or the lateral wall of the cavernous sinus.5 The purpose of this video is to describe the microsurgical anatomy of the MOB and illustrate the technique for its detachment, accompanied by 2 illustrative cases. To achieve this, we use 3-dimensional recordings of 2 cadaveric specimens’ dissections performed by the senior author. Case 1: 58-yr-old female with left blindness. Magnetic resonance imaging (MRI) shows an anterior and middle skull base lesion with orbital compression. Case 2: 32-yr-old male presenting with headache and trigeminal neuralgia. The MRI revealed an hourglass-shaped lesion in the posterior and middle fossa. Both patients signed an informed consent and agree with the use of their images for research purposes. We used a step-by-step approach for an adequate and secure dissection of the MOB highlighting the anatomic structures involved in the process. This approach allows safe and adequate access to the deeper structures of the anterior and middle skull base.

scholarly journals Imaging-Based Features of Headaches in Chiari Malformation Type I

Neurosurgery ◽  
2015 ◽  
Vol 77 (1) ◽  
pp. 96-103 ◽  
Author(s):  
Noam Alperin ◽  
James R. Loftus ◽  
Carlos J. Oliu ◽  
Ahmet M. Bagci ◽  
Sang H. Lee ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Chiari Malformation ◽  
Posterior Cranial Fossa ◽  
Type I ◽  
Intracranial Volume ◽  
Resonance Imaging ◽  
Chiari Malformation Type I ◽  
Intracranial Compliance ◽  
Cranial Fossa

Abstract BACKGROUND: Suboccipital cough-induced headaches are considered a hallmark symptom of Chiari malformation type I (CMI). However, non--Valsalva-related suboccipital headaches and headaches in other locations are also common in CMI. The diagnostic significance and the underlying factors associated with these different headaches types are not well understood. OBJECTIVE: To compare cranial morphology and hydrodynamics in 3 types of headaches in CMI to better understand the pathophysiological basis for the different headache characteristics. METHODS: Twenty-two cranial physiological and morphological measures were obtained with specialized magnetic resonance imaging scans from 63 symptomatic pretreated CMI patients, 40 with suboccipital headaches induced by Valsalva maneuvers (34 women; age, 36 ± 10 years), 15 with non--Valsalva-related suboccipital headaches (10 women; age, 33 ± 9 years), 8 with nonsuboccipital non--Valsalva-induced headaches (8 women; age, 39 ± 13 years), and 37 control subjects (24 women; age, 36 ± 12 years). Group differences were identified with the use of the 2-tailed Student t test. RESULTS: Posterior cranial fossa markers of CMI were similar among the 3 headache subtypes. However, the Valsalva-related suboccipital headaches cohort demonstrated a significantly lower intracranial compliance index than the non--Valsalva-related suboccipital headaches cohort (7.5 ± 3.4 vs 10.9 ± 4.9), lower intracranial volume change during the cardiac cycle (0.48 ± 0.19 vs 0.61 ± 0.16 mL), and higher magnetic resonance imaging--derived intracranial pressure (11.1 ± 4.3 vs 7.7 ± 2.8 mm Hg; P = .02). The Valsalva-related suboccipital headaches cohort had smaller intracranial and lateral ventricular volumes compared with the healthy cohort. The non--Valsalva-related suboccipital headaches cohort had reduced venous drainage through the jugular veins. CONCLUSION: Valsalva-induced worsening of occipital headaches appears to be related to a small intracranial volume rather than the smaller posterior cranial fossa. This explains the reduced intracranial compliance and corresponding higher pressure measured in CMI patients with headaches affected by Valsalva maneuvers.

scholarly journals Bell’s Cruciate paralysis in a patient victim of a gunshot wound in the cervical region

2018 ◽  
Vol 24 (2) ◽  
pp. 153-155
Author(s):  
Rodrigo Becco De Souza ◽  
Guilherme Brasileiro De Aguiar ◽  
Jefferson Walter Daniel ◽  
José Carlos Esteves Veiga
Keyword(s):  
Magnetic Resonance Imaging ◽  
Gunshot Wound ◽  
Corticospinal Tract ◽  
Lower Limbs ◽  
Cervical Region ◽  
Upper Limbs ◽  
Resonance Imaging ◽  
Present Case Report ◽  
Signal Change ◽  
Magnetic Resonance Imaging Mri

Bell’s cruciate paralysis is characterized by paralysis of the upper limbs associated with little or no deficit in lower limbs. Its diagnosis is often overlooked, given that its symptoms similarities to that occasioned by the centromedullary syndrome, whose incidence is considerably higher. The present case report describes the case of a 16-year-old male patient victim of a gunshot wound in the anterior cervical region that developed Bell’s cruciate paralysis. The Magnetic Resonance Imaging (MRI) of the cervical spine showed medullary signal change in the cervicomedullary junction, with anteromedial location. A somatotopy of the corticospinal tract was suggested by Bell (1970) at cervicomedullary transition, with the anatomical hypothesis that fibers responsible for the movement of the upper limbs would cross higher and more superficially that the fibers of the lower limbs. This case combines the MRI assessment with the clinical outcome and corroborates with the Bell’s anatomical theory. 

Sign in / Sign up

Export Citation Format

Share Document