Factors predicting the occurrence of syringomyelia in patients with Chiari I malformations

2019 ◽  
Vol 7 (8) ◽  
pp. 2967
Author(s):  
Vijayan Peettakkandy ◽  
Bijukrishnan Rajagopalawarrier ◽  
Sreenath Kuniyil ◽  
Jithin Veliyath Thankaraj
Keyword(s):  
Foramen Magnum ◽  
P Value ◽  
Tonsillar Herniation ◽  
Duration Of Symptoms ◽  
Medical College ◽  
Chiari I ◽  
The Mean ◽  
Time Of Presentation ◽  
Common Association ◽  
Cerebellar Tonsils

Background: Chiari I malformations are defined as the downward herniation of cerebellar tonsils more than 5 mm through the foramen magnum. Syringomyelia is a common association of Chiari I malformation.Methods: This purpose of this study was to determine the various factors predicting the occurrence of syringomyelia in patients with Chiari I malformations. This retrospective study was conducted in Government medical college, Thrissur, Kerala, India. 27 patients admitted with diagnosis of symptomatic Chiari I malformations during the period of January 2015 to January 2019 were selected for the study.Results: The mean age was 22.8 years and syringomyelia was more common in patients older than 10 years (p value0.005). Females were 17(63%) and males were 10(37%) but there no difference in occurrence of syringomyelia among both sexes(p value is 0.16). Syringomyelia was present in 17(63%) cases. Association between various factors and syringomyelia measured by calculating P value which was 0.005 for age >10 years, 0.16 for sex, 0.093 for duration of symptoms >12 months, 0.05 for tonsillar descend >10mm and 0.097 for hypertension. The p value for the association of duration of symptoms >12months and extend of tonsillar descend is 0.001 Mean duration of symptoms (onset of first symptom to the time of presentation) was 16.3 months and syringomyelia was more common in patients with duration of symptoms more than 12 months but this difference was statistically not significant (p value 0.093). Mean tonsillar descend from the level of foramen magnum was 11.3 mms and syringomyelia was more common in patients with tonsillar herniation more than 10mm (p value 0.05). There is a statistically significant relationship between duration of symptoms more than 12 months and tonsillar descend more than 10mm(p value 0.001).There is no significant association between hypertension and occurrence of syringomyelia in patients with Chiari I malformation.Conclusions: Incidence of Chiari I Malformations is more among adults and it is slightly higher in females. Syringomyelia is a common association of Chiari I Malformations. The occurrence of syringomyelia in patients with Chiari I Malformations associated with increasing age of patients and extend of tonsillar herniation. There is no statistically significant association between syringomyelia and duration of symptoms or hypertension.

scholarly journals Validity of the Diabetes, Hypertension and Hyperlipidaemia (DHL) Knowledge Instrument among Medical Students of Karachi

2016 ◽  
Vol 9 (1) ◽  
pp. 265
Author(s):  
Muhammad Bilal ◽  
Abdul Haseeb ◽  
Aleena Zehra Merchant ◽  
Muhammad Ahad Sher Khan ◽  
Arsalan Majeed Adam ◽  
...  
Keyword(s):  
Medical Education ◽  
Medical Students ◽  
Knowledge Score ◽  
Educational Status ◽  
Educational Programs ◽  
P Value ◽  
Medical College ◽  
Knowledge Based ◽  
The Mean ◽  
Knowledge Levels

BACKGROUND: While there have been a number of studies on DM, hypertension and hyperlipidaemia, an instrument which assesses knowledge based on all three conditions has neither been established nor authorized in Pakistan. Hence, the focus of this study was to establish a pre- tested extensive questionnaire to evaluate medical students’ understanding of DM, hypertension, hyperlipidaemia and their medications for use.METHODS: A pre-validated and pre-tested DHL instrument was employed on 250 students of Dow Medical and Sindh Medical College and on 45 physicians working in a leading teaching hospital of Karachi. The DHL knowledge instrument was then distributed a second time to the very same set of students, after a period of 2 months, at the end of the foundation module, once they had received some basic formal medical education including diabetes and CVS diseases.RESULTS: The overall internal consistency for the DHL instrument failed to comply with the set standard of more than or equal to 0.7 as our results yielded Cronbach’s α of 0.6. Overall the average difficulty factor of 28 questions is 0.41, which highlighted that the instrument was moderately tough. The mean scores for all domains were substantially lower in the students section in comparison to that of the professional section, which had remarkable impact on the overall mean(SD) knowledge score (40.58 ± 14.63 vs. 63.49 ± 06.67 ; p value = 0.00).CONCLUSION: The instrument can be used to recognize people who require educational programs and keep an account of the changes with the passage of time as it could help in differentiating the knowledge levels among its participants based on their educational status.

Outcome of Corticosteroid Injection in De Quervain's Tenosynovitis

2021 ◽  
Vol 15 (11) ◽  
pp. 3288-3292
Author(s):  
Wahid Bakhsh ◽  
Asad Ullah Jan ◽  
Muhammad Shafiq ◽  
Naveed Iqbal ◽  
Muzafar Hussain Buriro ◽  
...  
Keyword(s):  
Pain Score ◽  
Triamcinolone Acetonide ◽  
Corticosteroid Injection ◽  
Mean Value ◽  
Injection Pain ◽  
P Value ◽  
Duration Of Symptoms ◽  
De Quervain’S Tenosynovitis ◽  
Minimum Age ◽  
The Mean

Background: De Quervain's tenosynovitis is a painful and swollen stenosing tenosynovitis of the first dorsal compartment of the wrist. After analysing the patient's medical history and doing a physical examination, a diagnosis is made. Finkelstein's test is almost always positive. Objective: The goal of this study was to investigate the effectiveness of local corticosteroid injections in the treatment of de Quervain's tenosynovitis. Material & Methods: The study enrolled fifty patients with De Querven's Tenosynovitis. NSAIDs were provided orally and topically to all patients for an average of six weeks with no obvious improvement. Using a visual analogue scale, it was determined how much soreness would be felt in the first dorsal compartment and how much pain would be felt during the Finkelstein test. The edoema was removed by injecting a mixture of 1 mL (10 mg) triamcinolone-acetonide and 1 mL of 1% lidocain hydrochloride into the affected wrist's first dorsal compartment. They were subsequently examined every two weeks for twenty-four weeks. After a local triamcinolone acetonide injection, pain and discomfort on the radial side of the wrist were alleviated, and a negative Finkelstein test was done. Results: The mean age among the patients was 36.6 years with 12.4 SD. The maximum age was 60 years and the minimum age was 25 years old. The duration of symptoms in 4-8 weeks was observed, the mean value was 6 weeks with 1.4 as SD the minimum duration recorded was 4 weeks with 8 weeks as maximum duration. At the start of the week of appearance of symptoms the pain score was 6.44 with 1.6 as SD. The minimum pain score was 4 and maximum pain score was 8. Pain score at 4 weeks was 0.66 with 1.6 as SD. As per the independent t-test the p value was less than 0.05 so the test was significant statistically. Conclusion: One or two local steroid injections in the first dorsal compartment can give considerable pain and inflammation alleviation in people with de Quervain's tenosynovitis.

Complete posterior cranial vault distraction osteogenesis to correct Chiari malformation type I associated with craniosynostosis

2021 ◽  
pp. 1-7
Keyword(s):  
Foramen Magnum ◽  
Posterior Cranial Fossa ◽  
Type I ◽  
Intracranial Volume ◽  
Tonsillar Herniation ◽  
Chiari Malformation Type I ◽  
Cerebellar Tonsillar Herniation ◽  
Cranial Fossa ◽  
The Mean ◽  
Tonsillar Descent

OBJECTIVE Posterior vault distraction osteogenesis (PVDO) is an effective tool to increase intracranial volume and expand the posterior cranial fossa. During PVDO, the authors extended osteotomy posterior to the foramen magnum to fully expand the posterior cranial fossa. The aim of this study was to investigate the efficacy of complete PVDO in posterior fossa expansion and treatment of Chiari malformation type I (CM-I) in patients with craniosynostosis. METHODS Patients with craniosynostosis who had undergone complete PVDO between January 2012 and May 2020 were reviewed retrospectively. A coronal osteotomy extending to the foramen magnum was performed and the foramen magnum was decompressed by removing its posterior rim with a 1-mm Kerrison rongeur. Four distractor devices were placed and the vector of distraction was controlled from the posterior to the inferior-posterior direction, depending on the deformity. Changes in the intracranial volume, posterior cranial fossa area, and cerebellar tonsillar descent were measured after complete PVDO by using CT and MRI. RESULTS A total of 11 patients with craniosynostosis and concurrent CM-I were included in the study. The mean age was 34.6 ± 24.0 months (continuous variables are expressed as the mean ± SD throughout). One patient had sleep apnea, which was consistent with CM-I, and another patient had a headache, which was nonspecific. The intracranial volume increased from 1179.6 ± 180.2 cm3 to 1440.6 ± 251.5 cm3 (p = 0.003; 24.5% increase compared to the preoperative volume). The posterior skull base area increased from 44.9 ± 19.3 cm2 to 72.7 ± 18.1 cm2 (p = 0.004). Cerebellar tonsillar descent decreased in all 11 patients after complete PVDO (preoperative: 10.8 ± 3.7 mm, postoperative: 2.7 ± 3.0 mm; p = 0.003). Among the 11 patients, 5 showed complete resolution of cerebellar tonsillar herniation. CONCLUSIONS Complete PVDO can more efficiently expand the posterior cranial fossa, unlike conventional methods. Moreover, it helps to relieve cerebellar tonsillar herniation. Complete PVDO is a powerful tool to increase the intracranial and posterior fossa volumes in patients with craniosynostosis and concurrent CM-I.

95 Evaluating The Rate, The Predictors And The Outcomes Of Patients With Negative Appendectomy(NAR)

2021 ◽  
Vol 108 (Supplement_2) ◽  
Author(s):  
K Noureldin ◽  
A Ayantunde ◽  
M Elkholy ◽  
H S Shah Heer Shah ◽  
A Hatim
Keyword(s):  
Serum Bilirubin ◽  
Lower Abdominal Pain ◽  
Inflammatory Cells ◽  
Female Gender ◽  
P Value ◽  
Negative Appendectomy ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Negative Appendicectomy ◽  
Definition Of

Abstract Introduction Appendectomy is associated with complications and negative appendicectomy. We evaluated the rate and predictors of NAR in a cohort. Method Patients' data who underwent emergency appendicectomies over a year was analysed. A definition of NA; absence of inflammatory cells in the appendix. The NAR was calculated using (NAR-SDC) and (NAR-STC). Leucocytosis was a total WBC >11000/mm3, elevated CPR >5 mg/L. Results 372 patients were included. Median durations of symptoms 2 days. The mean admission WBC, CRP and serum bilirubin levels were 12,600 (3000-38000)/mm3, 66.9 (1-323) mg/L and 12.7 (4-38) µmol/L respectively. Laparoscopic appendectomy was performed in 93.5% with a conversion rate of 4.6%.NAR-SDC was 10.2% and NAR-STC was 25.8%. NAR was higher in females than males (39.4% versus 11.1%; p-value 0.0001). Patients with NA were younger (p-value 0.0001), had lower WBC (p-value 0.014), CRP (p-value 0.0001) levels on admission. Female gender, duration of symptoms more than 3 days, lower WBC were found to be predictors of NAR. Conclusions NA is a problem in management of patients with acute right lower abdominal pain. Our NAR compared favourably with reported rates. Female gender, symptoms more than 3 days, lower WBC were predictors of NA.

Chiari Malformation with Syringomyelia

2019 ◽  
pp. 57-64
Author(s):  
Yiping Li ◽  
Bermans J. Iskandar
Keyword(s):  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Neurological Deficits ◽  
Csf Leakage ◽  
Craniocervical Instability ◽  
Chiari I ◽  
Spine Mri ◽  
Operative Monitoring ◽  
Associated Abnormalities ◽  
Cerebellar Tonsils

Chiari I malformation (CIM) is defined by pathological herniation of the cerebellar tonsils below the foramen magnum. Operative intervention for CIM is generally undertaken to treat neurological deficits associated with tonsillar herniation or with associated syringomyelia. A complete brain and spine MRI is indicated to rule out associated abnormalities and to identify and the presence and extent of syringomyelia. The type of surgical decompression remains controversial but may include bone-only decompression, bony decompression followed by duraplasty, and bony decompression followed by duraplasty and tonsillar shrinkage. Post-operative monitoring for CSF leakage, inadequate decompression, subtle chronic craniocervical instability, and hydrocephalus is critical.

scholarly journals Chiari Malformation-I with Syringomyelia: A Non-specific Presentation and Surgical Consideration

2016 ◽  
Vol 13 (2) ◽  
pp. 105-108
Author(s):  
Jemesh S Maharjan ◽  
Pranaya Shrestha ◽  
Avinash Chandra ◽  
Pravesh Rajbhandari ◽  
Samir Acharya ◽  
...  
Keyword(s):  
Case Report ◽  
Chiari Malformation ◽  
Foramen Magnum ◽  
Clinical Findings ◽  
Tonsillar Herniation ◽  
Diverse Range ◽  
Broad Perspective ◽  
Surgical Options ◽  
Chiari I ◽  
Selection Of

Chiari Malformation-I is a congenital disorder characterized by the anatomical defect of the base of skull with tonsillar herniation (≥5 mm) below the foramen magnum, which is detected on MRI. It has a diverse range of symptoms with non-specific presentation leading to the chances of misdiagnosis and untimely recognition of the disorder. Syringomyelia is the most common result of Chiari-I. The selection of surgical or non-surgical management depends upon the patient symptoms and the presence of absence of Syringomyelia. The objective of this case report is to give a broad perspective on Chiari Malformation-I from the symptoms and clinical findings obtained in a patient with Syringomyelia associated with Chiari Malformation-I and to discuss about the different surgical options as well as the psychological support required for the management of the condition.Nepal Journal of Neuroscience. Vol. 13, No. 2, 2016, Page: 105-108 

Tonsillar herniation: the rule rather than the exception after lumboperitoneal shunting in the pediatric population

1993 ◽  
Vol 78 (4) ◽  
pp. 568-573 ◽  
Author(s):  
Paul D. Chumas ◽  
Derek C. Armstrong ◽  
James M. Drake ◽  
Abhaya V. Kulkarni ◽  
Harold J. Hoffman ◽  
...  
Keyword(s):  
Morphological Changes ◽  
Pediatric Population ◽  
Pseudotumor Cerebri ◽  
Foramen Magnum ◽  
Tonsillar Herniation ◽  
Content Type ◽  
Asymptomatic Patients ◽  
The Mean ◽  
Sick Children ◽  
Fine Print

✓ Although the development of tonsillar herniation (acquired Chiari malformation) in association with lumboperitoneal (LP) shunting is well recognized, it has previously been considered rare. In order to ascertain the incidence of this complication after LP shunting, the authors undertook a retrospective study of all patients in whom this form of shunt had been inserted between 1974 and 1991 at The Hospital for Sick Children, Toronto. In the 143 patients, the mean age at insertion was 3.3 years and the indications for shunt placement were hydrocephalus (81%), pseudotumor cerebri (7%), cerebrospinal fluid fistula (6%), and posterior fossa pseudomeningocele (6%). The mean follow-up period was 5.7 years, during which time there was one shunt-related death due to unsuspected tonsillar herniation. Five other patients developed symptomatic tonsillar herniation treated by suboccipital decompression. Review of all computerized tomography (CT) scans not degraded by artifact showed evidence of excess soft tissue at the level of the foramen magnum in 38 (70%) of 54 patients so studied. In order to confirm that this CT finding represented hindbrain herniation, sagittal and axial magnetic resonance (MR) images were obtained for 17 asymptomatic patients and revealed tonsillar herniation (range 2 to 21 mm) in 12 (70.6%). In addition, some of these asymptomatic patients had evidence of uncal herniation and mesencephalic distortion. Similarities and distinctions are drawn between the morphological changes occurring after LP shunting and those seen in association with the Chiari I and II malformations. Although less than 5% of this study population required treatment for tonsillar herniation, the incidence of this complication was high in asymptomatic patients; MR imaging surveillance for patients with LP shunts is therefore recommended.

Elucidating the pathophysiology of syringomyelia

1999 ◽  
Vol 91 (4) ◽  
pp. 553-562 ◽  
Author(s):  
John D. Heiss ◽  
Nicholas Patronas ◽  
Hetty L. DeVroom ◽  
Thomas Shawker ◽  
Robert Ennis ◽  
...  
Keyword(s):  
Mr Imaging ◽  
Subarachnoid Space ◽  
Foramen Magnum ◽  
Chiari I Malformation ◽  
Content Type ◽  
Cine Mr ◽  
Spinal Subarachnoid Space ◽  
Chiari I ◽  
Cerebellar Tonsils ◽  
Fine Print

Object. Syringomyelia causes progressive myelopathy. Most patients with syringomyelia have a Chiari I malformation of the cerebellar tonsils. Determination of the pathophysiological mechanisms underlying the progression of syringomyelia associated with the Chiari I malformation should improve strategies to halt progression of myelopathy.Methods. The authors prospectively studied 20 adult patients with both Chiari I malformation and symptomatic syringomyelia. Testing before surgery included the following: clinical examination; evaluation of anatomy by using T1-weighted magnetic resonance (MR) imaging; evaluation of the syrinx and cerebrospinal fluid (CSF) velocity and flow by using phase-contrast cine MR imaging; and evaluation of lumbar and cervical subarachnoid pressure at rest, during the Valsalva maneuver, during jugular compression, and following removal of CSF (CSF compliance measurement). During surgery, cardiac-gated ultrasonography and pressure measurements were obtained from the intracranial, cervical subarachnoid, and lumbar intrathecal spaces and syrinx. Six months after surgery, clinical examinations, MR imaging studies, and CSF pressure recordings were repeated. Clinical examinations and MR imaging studies were repeated annually. For comparison, 18 healthy volunteers underwent T1-weighted MR imaging, cine MR imaging, and cervical and lumbar subarachnoid pressure testing.Compared with healthy volunteers, before surgery, the patients had decreased anteroposterior diameters of the ventral and dorsal CSF spaces at the foramen magnum. In patients, CSF velocity at the foramen magnum was increased, but CSF flow was reduced. Transmission of intracranial pressure across the foramen magnum to the spinal subarachnoid space in response to jugular compression was partially obstructed. Spinal CSF compliance was reduced, whereas cervical subarachnoid pressure and pulse pressure were increased. Syrinx fluid flowed inferiorly during systole and superiorly during diastole on cine MR imaging. At surgery, the cerebellar tonsils abruptly descended during systole and ascended during diastole, and the upper pole of the syrinx contracted in a manner synchronous with tonsillar descent and with the peak systolic cervical subarachnoid pressure wave. Following surgery, the diameter of the CSF passages at the foramen magnum increased compared with preoperative values, and the maximum flow rate of CSF across the foramen magnum during systole increased. Transmission of pressure across the foramen magnum to the spinal subarachnoid space in response to jugular compression was normal and cervical subarachnoid mean pressure and pulse pressure decreased to normal. The maximum syrinx diameter decreased on MR imaging in all patients. Cine MR imaging documented reduced velocity and flow of the syrinx fluid. Clinical symptoms and signs improved or remained stable in all patients, and the tonsils resumed a normal shape.Conclusions. The progression of syringomyelia associated with Chiari I malformation is produced by the action of the cerebellar tonsils, which partially occlude the subarachnoid space at the foramen magnum and act as a piston on the partially enclosed spinal subarachnoid space. This creates enlarged cervical subarachnoid pressure waves that compress the spinal cord from without, not from within, and propagate syrinx fluid caudally with each heartbeat, which leads to syrinx progression. The disappearance of the abnormal shape and position of the tonsils after simple decompressive extraarachnoidal surgery suggests that the Chiari I malformation of the cerebellar tonsils is acquired, not congenital. Surgery limited to suboccipital craniectomy, C-1 laminectomy, and duraplasty eliminates this mechanism and eliminates syringomyelia and its progression without the risk of more invasive procedures.

scholarly journals MORPHOMETRIC ANALYSIS OF FORAMEN MAGNUM IN NORTH INDIAN POPULATION

2018 ◽  
Vol 26 (2) ◽  
Author(s):  
Poonam Srivastava ◽  
Medha Das ◽  
Shirin Jahan
Keyword(s):  
Morphometric Analysis ◽  
Indian Population ◽  
Uttar Pradesh ◽  
Foramen Magnum ◽  
Transverse Diameter ◽  
Brain Herniation ◽  
Medical College ◽  
The Mean ◽  
Large Opening ◽  
Human Skulls

Introduction: Foramen magnum is a large opening located in the occipital bone of the skull. The morphometric analysis of foramen magnum is clinically and surgically important because vital structures passing through it may suffer compression such as in cases of achondroplasia, brain herniation and meningiomas. Objectives: To study morphometric analysis of foramen magnum in dry human skulls and to measure its anteroposterior diameter, transverse diameter and foramen magnum index. Material & Methods: 100 dried human skulls of unknown age and sex were obtained from Department of Anatomy, Rama Medical College and GSVM Medical College, Kanpur, Uttar Pradesh, India. Deformed samples were excluded. Different parameters were measured with the help of Vernier caliper. Results: The mean antero-posterior diameter of foramen magnum was 33.79mm. The maximum antero-posterior diameter of foramen magnum was 40mm and minimum antero-posterior diameter was 28.2mm.The mean transverse diameter of foramen magnum was 28.30mm.The maximum transverse diameter of foramen magnum was 36mm and minimum transverse diameter was 21.5mm.The mean index of foramen magnum was 84.14mm. Conclusion: The morphometric analysis of foramen magnum and its variation is important not only for anatomists but also important to the anesthetists, neurosurgeons, orthopedicians and radiologists ; while planning and performing cranio-vertebral junction procedures.

scholarly journals STUDY OF MORPHOMETRIC ANALYSIS OF FORAMEN MAGNUM IN DRY HUMAN SKULL AT SMS MEDICAL COLLEGE, JAIPUR, RAJASTHAN

2021 ◽  
Vol 5 (3) ◽  
Author(s):  
Krati Bhardwaj ◽  
Chandrakala Agarwal ◽  
Dhiraj Saxena ◽  
Jitendra Singh
Keyword(s):  
Craniovertebral Junction ◽  
Foramen Magnum ◽  
Transverse Diameter ◽  
Male And Female ◽  
Human Skull ◽  
Medical College ◽  
The Mean ◽  
Medium Type ◽  
Skull Bones

Background: The present study was conducted for analysis of the morphometry shape and determination of sex by foramen Magnum. Methods: After applying inclusion and exclusion criteria 30 dried human skull of unknown age and sex were slected for present study from the Department of anatomy, S.M.S. Medical College, Jaipur, Rajasthan. In case of skull bones, all 30 cranial bases were visually assessed for FM shape classification. Each FM shape was classified into one of the 8 types: oval, egg, round, tetragonal, pentagonal, hexagonal, combination of 2 different semicircles and irregular. Results: The mean anteroposterior diameter of foramen magnum male and female skull bones were found to be 37.17±1.76 mm  and 33.92±3.50 mm respectively.The mean transverse diameter of foramen mgnum in male and female skull bones were found to be 29.49±2.68 mm and 29.38±2.47 mm respectively.The mean area of foramen magnum male and female skull bones were found to be 818.05±119.66 mm² and   847.57±105.85 mm² respectively.The mean index of foramen magnum in male and female skull bones were found to be 84.00±5.41 and 80.27±5.79 respectively.Overall skull bones showed a medium type of foramen magnum index . Conclusion: We concluded that the several anatomic parameters such as shape and dimensions of foramen magnum should be taken into consideration during surgery involving the craniovertebral junction. Also these can be used during forensic and anthropological investigation of unknown individuals for determining gender, ethnicity, etc Keywords: Skull, foramen magnum, skull.

Sign in / Sign up

Export Citation Format

Share Document