scholarly journals Spinal neuraxial anaesthesia for caesarean section in a parturient with type I Arnold Chiari malformation and syringomyelia

2018 ◽  
Vol 6 ◽  
pp. 2050313X1878611
Author(s):  
Miqi Mavis Teo
Keyword(s):  
Caesarean Section ◽  
Chiari Malformation ◽  
Elective Caesarean Section ◽  
Foramen Magnum ◽  
Surgical Decompression ◽  
Type I ◽  
Arnold Chiari Malformation ◽  
Neuraxial Anaesthesia ◽  
Current Guidelines

Introduction: Type 1 Arnold Chiari malformation is associated with prolapse of the cerebellar tonsils into or below the level of the foramen magnum and is usually diagnosed in adults. There are no current guidelines for the management of patients with a residual type I Arnold Chiari malformation, planned for a caesarean section under spinal neuraxial anaesthesia. The paucity in the literature on this topic presents as a management dilemma. Case report: We report a case of a term parturient with type 1 Arnold Chiari malformation, following surgical decompression 4 years earlier, with a residual syringomyelia that underwent an elective caesarean section under spinal neuraxial anaesthesia. Conclusion: This case highlights that multidisciplinary management and early anaesthetic consult are of paramount importance in the outcome of the patient, and that spinal neuraxial anaesthesia can be considered as a safe anaesthetic option.

scholarly journals Spinal neuraxial anaesthesia for Caesarean section in a parturient with Type I Arnold–Chiari malformation and syringomyelia

2018 ◽  
Vol 28 (2) ◽  
pp. 135-137
Author(s):  
Mavis Miqi Teo
Keyword(s):  
Caesarean Section ◽  
Chiari Malformation ◽  
Elective Caesarean Section ◽  
Foramen Magnum ◽  
Surgical Decompression ◽  
Type I ◽  
Arnold Chiari Malformation ◽  
Neuraxial Anaesthesia ◽  
Current Guidelines

Type 1 Arnold–Chiari Malformation is associated with prolapse of the cerebellar tonsils into or below the level of the foramen magnum and is usually diagnosed in adults. There are no current guidelines for the management of patients with a residual Type I Arnold–Chiari Malformation, planned for a Caesarean section under spinal neuraxial anaesthesia. The paucity of literature on this topic presents as a management dilemma. We report a case of a term parturient with Type 1 Arnold–Chiari Malformation, following surgical decompression four years earlier, with a residual syringomyelia who underwent an elective Caesarean section under spinal neuraxial anaesthesia. This case highlights that multidisciplinary management and an early anaesthetic consult is of paramount importance in the outcome of the patient, and that spinal neuraxial anaesthesia can be considered as a safe anaesthetic option.

The Association of Chiari Type I Malformation and Neurofibromatosis Type 1

1993 ◽  
Vol 32 (3) ◽  
pp. 189-190 ◽  
Author(s):  
Joseph Dooley ◽  
Daniel Vaughan ◽  
Michael Riding ◽  
Peter Camfield
Keyword(s):  
Neurofibromatosis Type 1 ◽  
Chiari Malformation ◽  
Neurofibromatosis Type ◽  
Foramen Magnum ◽  
Type I ◽  
Chiari Type ◽  
Chiari Type I Malformation ◽  
Chiari Type I ◽  
Chiari Malformations

The association of neurofibromatosis type 1 (NF1) with Chiari malformations of the cerebellum and brain stem has been reported on only two previous occasions.1,2 The pathogenesis of both conditions has remained unclear, although the Chiari type I malformation is most likely due to hypoplasia of the posterior fossa with subsequent extension of the cerebellum through the foramen magnum.3 NF1 is also associated with a variety of cerebral dysplasias.4 We present a patient with both of these dysplastic lesions whose Chiari malformation was asymptomatic.

scholarly journals Chiari 1 Malformation in a Child with Febrile Seizures, Parasomnias, and Sleep Apnea Syndrome

2017 ◽  
Vol 2017 ◽  
pp. 1-4
Author(s):  
Marco Zaffanello ◽  
Francesca Darra ◽  
Tommaso Lo Barco ◽  
Francesco Sala ◽  
Emma Gasperi ◽  
...  
Keyword(s):  
Chiari Malformation ◽  
Sleep Apnea Syndrome ◽  
Sleep Onset ◽  
Febrile Seizures ◽  
Female Child ◽  
Foramen Magnum ◽  
Type I ◽  
Cerebrospinal Fluid Circulation ◽  
Base Of The Skull

Introduction. The type I is the most common Chiari malformation in children. In this condition, the lower part of the cerebellum, but not the brain stem, extends into the foramen magnum at the base of the skull leading to disturbances in cerebrospinal fluid circulation and to direct compression of nervous tissue. Case report. We describe a 4-year-old Caucasian female child with febrile seizures, headache, parasomnias, and a delay of speech. The child underwent a magnetic resonance imaging to investigate these neurological signs, disclosing a Chiari malformation type 1. The polysomnography showed a mild-moderate sleep-disordered breathing, increased number of central sleep apneas, and generalized spike waves at sleep onset. Conclusions. Seizures have been seldom described in CM1 patients. The main reasons for performing MRI in this case were frequent seizures, a delay of speech, and headache, leading to an unexpected diagnosis of CM1. Polysomnography detected a discrete SDB.

Major Depressive Disorder Comorbid Severe Hydrocephalus Due to Arnold Chiari Malformation in an Apathetic Patient

2017 ◽  
Vol 41 (S1) ◽  
pp. S627-S627
Author(s):  
A. Kandeger ◽  
H.A. Guler ◽  
O. Guler
Keyword(s):  
Major Depressive Disorder ◽  
Depressive Disorder ◽  
Chiari Malformation ◽  
Brain Magnetic Resonance Imaging ◽  
Foramen Magnum ◽  
Psychiatric Evaluation ◽  
Major Depressive ◽  
Arnold Chiari Malformation ◽  
Severe Hydrocephalus

ObjectiveArnold Chiari Malformation (ACM) is a disorder of embryologic development that is characterized of herniation of the cerebellar structures through the foramen magnum by four types. ACM type 1 (ACM 1) consists in cerebellar tonsil herniation, which is sometimes associated with other abnormalities, including syringohydromyelia, hydrocephalus and skull base alterations. To date, five cases of psychiatric disorders comorbid with ACM-I have been reported. We here present an apathetic patient have delayed diagnosis ACM-I and severe hydrocephalus and comorbid major depressive disorder.CaseA 36-year-old, male patient who is married and two children, was admitted to hospital with don’t want to make anything, despondency, thoughts of have an incompetency, uselessness and want to death, tiredness, weakness complaints which are increased day by day last 2 months. He was diagnosed with major depression after the psychiatric evaluation and hospitalised. He has unwillingness, tiredness and headache complaints which are started when he was 20 years old and he used antidepressant, anxiolytic, and low dose anthipsycotic drugs under psychiatrist control at this years. In radiologic evaluation, Arnold Chiari type 1 and severe hydrocephalus was detected in brain magnetic resonance imaging.DiscussionACM 1 is related to hydrocephalus as a result of posterior fossa hypoplasia and causes spinal injury by obstruction to cerebrospinal fluid (CSF) flow at the foramen magnum. Apathy is a common yet often overlooked symptom in hydrocephalus. This symptom may be a significant obstacle for cognition and quality of life and is associated with increased level of depression.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Arnold-Chiari malformation

1983 ◽  
Vol 58 (2) ◽  
pp. 183-187 ◽  
Author(s):  
Kamal S. Paul ◽  
Richard H. Lye ◽  
F. Alexander Strang ◽  
John Dutton
Keyword(s):  
Posterior Fossa ◽  
Chiari Malformation ◽  
Significant Proportion ◽  
Foramen Magnum ◽  
Posterior Fossa Decompression ◽  
Type I ◽  
Cerebellar Syndrome ◽  
Adult Type ◽  
Arnold Chiari Malformation ◽  
Central Cord Syndrome

✓ The natural history of symptomatic adult Type I Arnold-Chiari malformation (ACM) is variable, and the value of surgery in the management of this disease is difficult to assess. A series of 71 patients in whom a diagnosis of Type I ACM was confirmed at operation is presented, and the progress of the patients following posterior fossa decompression is analyzed. The length of history varied greatly. Pain was the commonest symptom (69% of patients); other symptoms included weakness (56%), numbness (52%), and unsteadiness (40%). The presenting physical signs consisted of a foramen magnum compression syndrome (22%), central cord syndrome (65%), or a cerebellar syndrome (11%). Myelography was performed in 69 patients, and was the most useful investigation. Only 23% of plain radiographs were abnormal. In addition to tonsillar descent, the operative findings included arachnoid adhesions (41%) and syringomyelia (32%). All patients underwent suboccipital craniectomy and C1–3 laminectomy. Respiratory depression was the most frequent postoperative complication (14%), and one patient died from sleep apnea. Early postoperative improvement of both symptoms (82%) and signs (70%) was followed by later relapse in 21% of patients, showing an initial benefit following surgery. None of the patients with a cerebellar syndrome deteriorated, whereas 56% of patients with evidence of foramen magnum compression and 66% of those with a central cord syndrome maintained their initial improvement. The authors conclude that posterior fossa decompression appears to benefit some patients, although a significant proportion might be expected to relapse within 2 to 3 years after operation, depending upon the presenting syndrome.

Factitious disorder in a patient with Arnold-Chiari malformation: A case report

2017 ◽  
Vol 41 (S1) ◽  
pp. S473-S473
Author(s):  
D. Celona ◽  
F. Sandri ◽  
E. Pascolo Fabrici ◽  
G. Peresson ◽  
D. Garino
Keyword(s):  
Chiari Malformation ◽  
Complete Resolution ◽  
Psychological Symptoms ◽  
Foramen Magnum ◽  
Type I ◽  
Factitious Disorder ◽  
Chiari Malformation Type I ◽  
Arnold Chiari Malformation ◽  
The Subject ◽  
Competing Interest

IntroductionThe factitious disorder is characterized by simulation or exaggeration by the subject of his/her physical or psychological symptoms to take a sick role. This disorder may be associated with a real disease, used to simulate other symptoms and receive treatment. Our case is represented by a 49-year-old man, affected by Arnold Chiari Malformation Type I (ACM-I), a structural defect in the cerebellum with extension of the cerebellar tonsils into the foramen magnum, without involving the brain stem. The patient had three surgical operations involving the complete resolution of the disease. However, the subject reported a worsening of all symptoms, with the outcome of a severe self-limitation, with admission to a residential care and taken over by the multidisciplinary equipe of the district. Symptoms, which mainly consisted in pain, motor functional impairment, headaches, slurred speech were not evaluated due to the ACM-I. This diagnosis was confirmed when there was the complete resolution of the symptoms in a date pointed by the patient.MethodsTo make an appropriate differential diagnosis, in addition to the neurological examination, the subject had psychiatric interviews and completed an MMPI evaluation.ResultsNeurological examinations revealed no residual outcome of the ACM-I. At MMPI there were not significant peaks. Regarding to the attitude towards this test and its validity, it appears an obvious attempt to lie from the patient, which tries to present himself in a favourable unrealistically way.ConclusionThis case shows that appropriate diagnosis can help health services in a better management of their resources in such situations.Disclosure of interestThe authors have not supplied their declaration of competing interest.

scholarly journals Clinical outcome following duraplasty in type 1 Arnold Chiari malformation

2019 ◽  
Vol 6 (3) ◽  
pp. 857
Author(s):  
Guruprasad Bettaswamy ◽  
Rajesh R. Raykar ◽  
Rajesh Kumar Singh ◽  
Mahendra M.
Keyword(s):  
Clinical Outcome ◽  
Neck Pain ◽  
Clinical Improvement ◽  
Chiari Malformation ◽  
Foramen Magnum ◽  
Type I ◽  
Foramen Magnum Decompression ◽  
Improvement Rate ◽  
Female Ratio

Background: Few authors support the use of duraplasty and few authors have reported a higher rate of complications associated with the same. The objective of the present endeavor was to study clinical outcome following duraplasty in type 1 Arnold Chiari malformation.Methods: Retrospectively, 24 cases and prospectively 18 cases diagnosed and operated for Chiari malformation type I were included. Patients with Chiari type II, III, and IV were excluded. A questionnaire was used to assess the improvement in neck pain and disability due to it, head pain and disability due to it and improvement in general health before and one year after surgery. The results of the questionnaire of both groups were analyzed and compared.Results: The most common age group of presentation was 2nd decade (35.71%) followed by 3rd decade (26.19%). The male to female ratio was 1.2:1. The most common presenting complaint was sensory disturbances (66.66%) followed by neck pain in 14 patients (33.33%). The most common sign was limb weakness in 21 patients (50%). 24 patients were operated with foramen magnum decompression with duraplasty and 18 patients were operated without duraplasty. There were more complications in the duraplasty group. Patients showed an overall clinical improvement of 83.33% in the duraplasty group compared to a lower overall clinical improvement rate of 55.50% in the no duraplasty group. Specific symptoms like neck pain showed similar rate of improvement of (88.89%) in the duraplasty group compared to no duraplasty group (80%).Conclusions: Foramen magnum decompression with duraplasty is superior to foramen magnum decompression without duraplasty although slightly higher rate of complication is seen with duraplasty.

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