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1.
World Neurosurg ; 132: 67-68, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31479794

RESUMO

Ehlers-Danlos syndrome can be associated with cerebrospinal fluid (CSF) disturbances including recurrent CSF leak and Chiari I malformations. Persistent pseudomeningoceles are known to be associated with raised intracranial pressure. We present an unusual case of a compressive epidural CSF collection occurring after a computed tomography-guided L5 nerve root block and describe an effective management strategy.


Assuntos
Vazamento de Líquido Cefalorraquidiano/etiologia , Síndrome de Ehlers-Danlos/complicações , Injeções Epidurais/efeitos adversos , Hipertensão Intracraniana/complicações , Compressão da Medula Espinal/etiologia , Adulto , Malformação de Arnold-Chiari/complicações , Vazamento de Líquido Cefalorraquidiano/diagnóstico por imagem , Vazamento de Líquido Cefalorraquidiano/cirurgia , Feminino , Humanos , Vértebras Lombares , Bloqueio Nervoso , Radiculopatia/tratamento farmacológico , Radiculopatia/etiologia , Compressão da Medula Espinal/diagnóstico por imagem , Compressão da Medula Espinal/cirurgia , Espondilolistese/complicações , Tomografia Computadorizada por Raios X
2.
Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi ; 33(9): 840-844;847, 2019 Sep.
Artigo em Chinês | MEDLINE | ID: mdl-31446700

RESUMO

Summary Chiari malformation type Ⅰ(CMI) is a disorder characterized by tonsilla cerebelli herniating into an underdeveloped posterior cranial fossa, hearing loss is often covered by more striking neurological symptoms. Hearing loss in this syndrome is not specific in terms of gender side, degree, age of onset, and progression. The hearing improvement after posterior fossa decompression is controversial on the basis of literature, while satisfactory result was obtained after cochlear implantation in the patient reported here, who was diagnosed as CMI with hearing loss as the main symptom. Therefore, after ensuring the integrity of the auditory pathway, cochlear implantation may be considered in CMI patients with bilateral severe or profound without other severe neurological symptoms.


Assuntos
Malformação de Arnold-Chiari/complicações , Implante Coclear , Surdez/etiologia , Surdez/cirurgia , Fossa Craniana Posterior/patologia , Audição , Humanos , Resultado do Tratamento
3.
J Clin Neurosci ; 69: 279-280, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31447362

RESUMO

A 23-year old man was found to have a Chiari Type 1 malformation and cerebellar atrophy. While this association has previously been described, the remote cerebellar atrophy is difficult to explain. We believe the answer lies with our finding of signal hyperintensity on MR imaging at the level of the inferior olives. This suggest hypertrophic olivary degeneration, caused by trans-synaptic degeneration following disruption to the Guillain-Mollaret triangle. Propagation of this process to the cerebellar Purkinje cells occurs in some cases. We describe a case in support of this hypothesis and review previously published evidence.


Assuntos
Malformação de Arnold-Chiari/patologia , Doenças Cerebelares/patologia , Núcleo Olivar/patologia , Degeneração Retrógrada/patologia , Malformação de Arnold-Chiari/complicações , Atrofia/patologia , Doenças Cerebelares/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Adulto Jovem
4.
World Neurosurg ; 131: 120-125, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31400526

RESUMO

BACKGROUND: A noninvasive approach for basilar invagination (BI) and moreover, cervical traction to reduce odontoid invagination, has not been thoroughly described in the literature. We report a case of BI with Arnold-Chiari malformation in which preoperative reduction using Gardner well cervical traction was attempted and the patient developed central hypoventilation syndrome. CASE DESCRIPTION: A 15-year-old boy presented with a 6-month history of progressive cervical myelopathy signs and symptoms, modified Japanese orthopedic association score 12 of 18. Radiology showed type A BI with occipitalization of atlas and a posterior arch defect of axis. A preoperative closed cervical traction followed by occipitocervical fusion via a posterior-only approach was planned. The patient developed 3 episodes of apnea on sleeping when on traction. Labeled as central hypoventilation, he was operated by foramen magnum decompression and occipitocervical fusion. CONCLUSIONS: Cervical traction followed by posterior fixation is an effective way to manage basilar invagination with Arnold-Chiari malformation and assimilated C1. However, patients should be monitored closely for respiratory dysfunction.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Articulação Atlantoccipital/cirurgia , Apneia do Sono Tipo Central/etiologia , Doenças da Coluna Vertebral/cirurgia , Tração/efeitos adversos , Adolescente , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Articulação Atlantoccipital/diagnóstico por imagem , Descompressão Cirúrgica/métodos , Humanos , Masculino , Doenças da Coluna Vertebral/complicações , Doenças da Coluna Vertebral/diagnóstico por imagem , Fusão Vertebral/métodos
5.
World Neurosurg ; 130: 432-438, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31351204

RESUMO

BACKGROUND: The natural course of syringomyelia is unpredictable. Only a few cases of adults with spontaneous resolution of syringomyelia associated with Chiari malformation type I (CM-I) have been reported. The timing of surgical intervention for syringomyelia remains controversial. The present report has documented a case with the longest medical history of syringomyelia reported, the associated imaging findings over 16 years, the mild symptom progression after the spontaneous resolution of syringomyelia, and a review of the relevant reported data. The natural history of our patient provides a unique view regarding the factors that might lead to the development and spontaneous resolution of syringomyelia. CASE DESCRIPTION: We present the case of a 36-year-old woman who had been monitored for 16 years for mild symptomatic CM-I and syringomyelia. After regular follow-up examinations for the initial 10 years, magnetic resonance imaging revealed partial spontaneous resolution of the syringomyelia and unchanged symptoms. However, after 6 additional years of follow-up examinations, her symptoms had mildly progressed, and the size of the syringomyelia had obviously decreased. CONCLUSIONS: The findings from our patient suggest that the natural course of mild symptomatic CM-I in adult patients will be benign and nonprogressive. Patients will commonly present with very few or mild symptoms, despite the presence of a large syrinx. It would be reasonable to observe patients with similar mild symptoms and syringomyelia. Surgery will be indicated by the type, severity, and duration of symptoms at the first clinical visit. Periodic follow-up examinations are also essential after spontaneous resolution because the pathophysiology of syringomyelia is incompletely understood and recurrence possible.


Assuntos
Siringomielia/patologia , Adulto , Assistência ao Convalescente , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/patologia , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Remissão Espontânea , Siringomielia/complicações
6.
J Craniofac Surg ; 30(5): e397-e400, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31299790

RESUMO

The fourth ventricle outlet obstruction (FVOO) is a rare but well-established cause of obstructive tetra-ventricular hydrocephalus, characterizing with dilatation or large cerebrospinal fluid collection of the foramina of Magendie and Luschka. In children, it is usually the consequence of posterior cerebral fossa malformations; while in adult, the occlusion is rather acquired than congenital, mostly linked to an inflammatory process, intraventricular hemorrhage, head trauma, brain tumors or Arnold-Chiari malformation. However, idiopathic FVOO is extremely rare, and only 6 such cases have been reported in the English literature. Hereby, we described an extraordinarily rare case of idiopathic FVOO in a 15-year-old patient successfully treated with direct microsurgical excision of the obstruction membrane. Furthermore, the clinical characteristics and treatment for this rare disease were investigated and reviewed.


Assuntos
Quarto Ventrículo/cirurgia , Hidrocefalia/cirurgia , Adolescente , Malformação de Arnold-Chiari/complicações , Neoplasias Encefálicas/patologia , Hemorragia Cerebral/complicações , Traumatismos Craniocerebrais/complicações , Humanos , Doenças Raras/patologia
7.
Int J Pediatr Otorhinolaryngol ; 124: 152-156, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31195309

RESUMO

BACKGROUND: Gorham-Stout disease (GSD) is a rare lymphatic disorder which results in bone destruction. Defects of the skull base are difficult to manage, we describe cases to better understand the disease and discuss treatment. METHODS: Retrospective study including all patients treated for GSD skull-base defects. Medical records, clinical, imaging and treatment data were studied. A systematic review of the literature included case reports of the diseases for further analysis. RESULTS: 6 patients (5 males, 1 female) were included. Mean age at diagnosis was 3.5 years (range 0-10). Follow-up was of 5.2 years. Patients were divided into Naso-temporal (NT) and Vertebro-temporal (VT) groups following anatomical location. NT patients (4 patients) all had petrous defects extending anteriorly, including sphenoid, ethmoidal and mandibular defects. They all had cerebro-spinal fluid leak (CSF) and recurrent meningitis (range from 3 to 7). Two of those patients had sequelae including deafness, paralysis and epilepsy. VT patients (2 patients) all had temporal, occipital bone and cervical vertebrae defects. None had CSF leaks but both died from medullar compression (preceded by tetraparesis in one case). Overall, five out of six patients had type I Chiari malformation. Interferon seemed to be the most efficient medical treatment. Surgery included petrectomy, endonasal surgery for CSF leak management and neurosurgery for medullar management but could not guarantee long-term effects. CONCLUSION: Main issues in skull base defects are CSF leaks and medullar compressions. Surgical treatment is necessary in both cases but can only be satisfactory if general medical treatment can stabilise the disease.


Assuntos
Osteólise Essencial/cirurgia , Base do Crânio , Malformação de Arnold-Chiari/complicações , Vazamento de Líquido Cefalorraquidiano/diagnóstico , Vazamento de Líquido Cefalorraquidiano/etiologia , Vazamento de Líquido Cefalorraquidiano/cirurgia , Criança , Pré-Escolar , Endoscopia , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Procedimentos Neurocirúrgicos , Osteólise Essencial/complicações , Osteólise Essencial/diagnóstico por imagem , Estudos Retrospectivos
8.
World Neurosurg ; 130: e74-e81, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31158545

RESUMO

OBJECTIVE: The pathogenesis of Chiari malformation type 1 (CM-1)-associated Valsalva headache is unknown, but it may be caused by abnormal cerebellar tonsil tissue strain. Advances in cardiac-gated magnetic resonance imaging (MRI) techniques such as balanced fast-field echo (bFFE) allow quantification of the motion of anatomic structures and can be used to measure tissue strain. The current study investigated the relationship between Valsalva heachache and tonsillar motion in patients with CM-1. METHODS: A retrospective review of patients with CM-1 who had undergone cardiac-gated bFFE MRI was performed. Headache symptoms were retrieved from the medical records. Anatomic landmarks were manually selected on the cine bFFE, and a validated motion-tracking software was used to assess motion over the cardiac cycle in patients at rest. For each patient, displacement, strain, and strain rate were calculated for 3 anatomic segments. Patients undergoing surgery were examined before and after surgery. RESULTS: From 88 patients, a total of 108 bFFE sequences were analyzed. Valsalva headache was present in 50% of patients. Cerebellar tonsil displacement (P = 0.003), strain (P = 0.012), and maximum strain rate (P = 0.04) were reduced after surgery (n = 20). There was no statistically significant association between tissue motion and headache symptoms. CONCLUSION: The results of this study do not support a relationship between cardiac cycle cerebellar strain and Valsalva headache in patients with CM-1. It is possible that cerebellar strain related to respiratory maneuvers is associated with headache in Chiari patients. Further investigation of tissue strain is warranted because it represents a potential biomarker for outcomes after surgery.


Assuntos
Malformação de Arnold-Chiari/patologia , Cerebelo/patologia , Cefaleia/patologia , Adulto , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Feminino , Cefaleia/diagnóstico por imagem , Cefaleia/etiologia , Humanos , Imagem por Ressonância Magnética/métodos , Masculino , Estudos Retrospectivos
9.
Tidsskr Nor Laegeforen ; 139(10)2019 06 25.
Artigo em Norueguês | MEDLINE | ID: mdl-31238671

RESUMO

Chiari malformation denotes a pathological caudal ectopy of the cerebellar tonsils below the level of the foramen magnum. Several types of the condition exist, of which Type 1 is the most common. It often results in few if any symptoms, and in many cases is detected as an incidental finding when an MRI is performed. Symptoms such as headache, dizziness or nausea may be related to narrowing of the foramen magnum due to blocked circulation of spinal fluid. Surgical treatment must be considered in symptomatic cases.


Assuntos
Malformação de Arnold-Chiari , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/fisiopatologia , Malformação de Arnold-Chiari/cirurgia , Humanos , Imagem por Ressonância Magnética
10.
Disabil Health J ; 12(4): 649-656, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31147250

RESUMO

BACKGROUND: 50% of patients with Chiari Malformation (CM) report a history of depression; however, rates of other psychological symptoms are unknown. Further, it is unclear whether surgical correction impacts pain, disability, and psychological symptoms. OBJECTIVE: /Hypothesis: We examined rates of symptoms in a nationwide sample of CM patients who had (n = 639) and had not (n = 551) undergone surgical correction. We hypothesized lower symptom severity in the latter group. METHODS: Participants completed assessments and submitted pre-surgical MRI scans online (n = 286). Informed by the Fear-Avoidance Model of pain, we controlled for psychological symptoms when assessing pain/disability, and pain/disability when assessing psychological symptoms. RESULTS: Overall, high rates of depression (44% moderate-severe) and anxiety (60% moderate-severe) were reported. Groups (surgery vs. no-surgery) did not differ in the proportion of patients meeting cutoff scores for current disability; however, the no-surgery group was more likely to meet cutoffs for anxiety (χ2 = 11.26, p < .05), stress (χ2 = 14.63, p < .01) and health anxiety (χ2 = 4.63, p < .05). The surgery group reported lower levels of continuous affective pain F(1, 1065) = 10.28, p < .001), anxiety F(1,1026) = 4.96, p < .05) and stress F(1, 978) = 5.67, p < .05) although effect sizes were small (η2s ranging from 0.010 to 0.006, Cohen's D ranging from 0.17 to 0.25). CONCLUSION: CM patients experience high rates of psychological symptomatology regardless of surgical status, suggesting that all CM patients may benefit from evidence-based interventions to address anxiety and depression.


Assuntos
Ansiedade/etiologia , Malformação de Arnold-Chiari/complicações , Depressão/etiologia , Pessoas com Deficiência/psicologia , Dor/etiologia , Estresse Psicológico/etiologia , Adolescente , Adulto , Idoso , Ansiedade/epidemiologia , Transtornos de Ansiedade/epidemiologia , Transtornos de Ansiedade/etiologia , Malformação de Arnold-Chiari/psicologia , Malformação de Arnold-Chiari/cirurgia , Depressão/epidemiologia , Transtorno Depressivo/epidemiologia , Transtorno Depressivo/etiologia , Medo , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor/epidemiologia , Dor/psicologia , Estresse Psicológico/epidemiologia , Adulto Jovem
11.
World Neurosurg ; 128: 248-253, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31048052

RESUMO

BACKGROUND: An intraoperative technique for foramen magnum decompression of Chiari malformation is presented. The technique uses minimal exposure tubular retractors attached to a flexible arm to keep the retractor in a fixed position, while allowing flexible angulation under fluoroscopic guidance. METHODS: Operations were performed between 2009 and 2018 on 22 patients with cerebellar tonsillar descent below the foramen magnum and a diagnosis of type I Chiari malformation. A linear durotomy was necessary, but only the outer layer of the dura was opened for some patients, which is less invasive than the traditional procedure where a durotomy is performed for both the inner and outer layers, and then a duraplasty is performed. RESULTS: The approach allowed access to a wide working area, minimized soft tissue exposure, and optimized extent of decompression. The postoperative imaging demonstrated satisfactory bony removal, and magnetic resonance imaging of the area with cerebrospinal (CSF) flow study showed good CSF flow across the foramen magnum. There was a low incidence of postoperative complications, and the average length of hospital stay was 1 day. For 19 of 22 cases, the symptoms completely resolved or markedly improved, and each of the patients who attended the last follow-up demonstrated syrinx resolution. CONCLUSIONS: Based on our experience with this technique, when used to assist in foramen magnum decompression of Chiari malformation I, the minimally invasive tubular retractor is a useful tool, providing the surgeon with enhanced visualization of the operative field, while reducing potential damage to tissue and optimizing surgical outcomes.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Descompressão Cirúrgica/métodos , Forame Magno/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos/métodos , Procedimentos Neurocirúrgicos/métodos , Adulto , Idoso , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Ataxia/etiologia , Tontura/etiologia , Dura-Máter/cirurgia , Disartria/etiologia , Dor Facial/etiologia , Feminino , Forame Magno/diagnóstico por imagem , Cefaleia/etiologia , Humanos , Tempo de Internação , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Procedimentos Cirúrgicos Minimamente Invasivos/instrumentação , Procedimentos Neurocirúrgicos/instrumentação , Reflexo Anormal , Tração/instrumentação , Adulto Jovem
12.
World Neurosurg ; 128: 501-505, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31077896

RESUMO

BACKGROUND: Chiari malformation results from a bony structural anomaly of the skull base. The structural defect causes downward displacement of the cerebellar tonsils through the foramen magnum. The herniated tonsils block the normal flow of cerebrospinal fluid, which causes a wide spectrum of clinical symptoms. CASE REPORT: In May 2015, a 16-year-old girl was referred to our center because of a 1-year history of occipital headache, most often triggered by exercise and physical activity at school. She had experienced new-onset numbness in both hands, more severe on the right side, associated with some degrees of weakness. Eventually, an evaluation of her condition included magnetic resonance imaging in T1 and T2 sequences, which revealed a 20-mm downward migration of the cerebellar tonsils, associated with a cervical cord syrinx at the level of the fourth and fifth cervical vertebrae. The patient underwent posterior fossa decompression and C1 and partial C2 laminectomies. Postoperatively there were no complications, and the patient was discharged on day 3. Postoperatively, she experienced some improvement in her symptoms. After 2 months of routine outpatient follow-up, she was better, the headaches had subsided, she could resume some activities, and there was no paresis in her limbs. CONCLUSIONS: In cases of progressive symptoms of Chiari malformation, surgical decompression is important and should be considered after shunt insertion to the hindbrain.


Assuntos
Malformação de Arnold-Chiari/cirurgia , Cistos do Sistema Nervoso Central/cirurgia , Cerebelo/cirurgia , Complicações Pós-Operatórias/cirurgia , Adolescente , Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Cistos do Sistema Nervoso Central/diagnóstico por imagem , Cerebelo/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Complicações Pós-Operatórias/diagnóstico por imagem , Siringomielia/complicações , Siringomielia/diagnóstico por imagem
13.
Neuropsychology ; 33(5): 725-738, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31094552

RESUMO

BACKGROUND: Idiopathic descent of cerebellar tonsils into the cervical spine in Chiari malformation Type I (CMI) is typically associated with occipital headache. Accumulating evidence from experimental studies suggests cognitive effects of CMI. The aim of the current study was to examine the relationship between cognition and CMI using a battery of standardized neuropsychological and symptom inventory instruments. METHOD: Eighteen untreated adults with CMI, and 18 gender, age, and education matched healthy controls completed the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and standardized measures of pain, mood, and disability. Morphometric measurements of key neural and osseous elements were also obtained from structural brain magnetic resonance images, for correlation with symptom outcomes. RESULTS: CMI patients exhibited deficits in RBANS attention, immediate memory, delayed memory, and total score. After controlling for pain and associated affective disturbance, the significant group effect for RBANS attention remained. CMI patients also presented seven morphometric differences comprising the cerebellum and posterior cranial fossa compartment that differed from healthy controls, some of which were associated with self-reported pain and disability. Notably, group differences in tonsillar position were associated with self-reported pain, disability, and delayed memory. CONCLUSION: Adult CMI is associated with domain-specific cognitive change, detectable using a standard clinical instrument. The extent of cognitive impairment is independent of pain or affective symptomatology and may be related to the key pathognomonic feature of the condition. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/patologia , Cerebelo/patologia , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/fisiopatologia , Fossa Craniana Posterior/patologia , Adolescente , Adulto , Cerebelo/diagnóstico por imagem , Fossa Craniana Posterior/diagnóstico por imagem , Feminino , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Testes Neuropsicológicos , Adulto Jovem
14.
Am J Case Rep ; 20: 719-722, 2019 May 20.
Artigo em Inglês | MEDLINE | ID: mdl-31105263

RESUMO

BACKGROUND Arthrogryposis multiplex congenita is a multifactorial syndromic or non-syndromic group of conditions consisting of multiple congenital contractures of the body, of unknown etiology. It is associated with a heterogenous group of disorders that include but are not limited to processes such as myopathic and neuropathic. Neural tube defect is a neuropathic disorder that incorporates myelomeningocele that might be either isolated or within a spectrum of multiple diseases. CASE REPORT This is a case report of a 28-day-old male born with lower limb arthrogryposis with myelomeningocele and Chiari II malformation in a Mediterranean population. CONCLUSIONS Lower extremity arthrogryposis with myelomeningocele and Chiari II malformation is a prenatal diagnosis that requires high clinical suspicion, early multidisciplinary intervention, and genetic counselling. As long as new approaches are being explored in the management of such cases, babies born now with neural tube defects can expect better quality of life.


Assuntos
Malformação de Arnold-Chiari/diagnóstico , Malformação de Arnold-Chiari/terapia , Artrogripose/diagnóstico , Artrogripose/terapia , Meningocele/diagnóstico , Meningocele/terapia , Malformação de Arnold-Chiari/complicações , Artrogripose/complicações , Humanos , Recém-Nascido , Masculino , Meningocele/complicações
15.
World Neurosurg ; 129: 45-48, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31121377

RESUMO

BACKGROUND: Pituitary adenomas (PA) are usually benign neoplasms. Chiari I malformation (CIM) is an uncommon finding. Isolated cases associating functional PA and CIM have been reported. The concomitant presence of a nonfunctional PA and a CIM has not yet been described in the literature. CASE DESCRIPTION: We present the case of a 35-year-old patient whose symptoms were compatible with CIM. Magnetic resonance imaging of the brain, with and without contrast material, confirmed the CIM and incidentally encountered a PA. The patient was treated initially for her PA through an endoscopic endonasal approach with complete tumor resection, confirming a nonfunctional PA. Posterior fossa decompression was successfully accomplished 3 months later. The patient has been followed up for 5 years and has been free of symptoms, with no recurrence of her PA. This represents the first reported case of a nonfunctional PA with a concomitant CIM. CONCLUSION: This is the first reported case of a concomitant CIM and a nonfunctional PA. We discuss our successful management and conduct a systematic review of the literature to provide the most up-to-date guidance on managing these singular cases with concomitant pathologic conditions.


Assuntos
Adenoma/complicações , Malformação de Arnold-Chiari/complicações , Neoplasias Hipofisárias/complicações , Adenoma/diagnóstico , Adenoma/cirurgia , Adulto , Malformação de Arnold-Chiari/cirurgia , Feminino , Humanos , Achados Incidentais , Neoplasias Hipofisárias/diagnóstico , Neoplasias Hipofisárias/cirurgia
17.
Clinics (Sao Paulo) ; 74: e653, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30970117

RESUMO

Basilar invagination (BI) and Chiari malformation type I (CM-I) are very important anomalies that introduce instability and compression in the occipitocervical transition region and have complex clinical characteristics. These anomalies vary according to the affected structures. The present study revises current knowledge regarding the anatomy, anatomo-physiology, clinical manifestations, and radiological findings of these entities and the associated surgical treatment approaches. A bibliographic survey was performed through a search in the Medline, PubMed, SciELO, Science and LILACS databases. When associated, these craniovertebral malformations result in neurological deficits due to neural parenchyma compression; however, the presence of microtraumas due to repetitive lesions caused by the bulb and cervical marrow instability has been highlighted as a determinant dysfunction. Surgical treatment is controversial and has many technical variations. Surgery is also challenging due to the complex anatomical characteristics and biomechanics of this region. Nevertheless, advances have been achieved in our understanding of related mechanisms, and compression and atlantoaxial instability are considered key elements when selecting the surgical approach.


Assuntos
Malformação de Arnold-Chiari/complicações , Platibasia/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Malformação de Arnold-Chiari/fisiopatologia , Malformação de Arnold-Chiari/cirurgia , Descompressão Cirúrgica/métodos , Humanos , Instabilidade Articular/fisiopatologia , Imagem por Ressonância Magnética/métodos , Processo Odontoide/fisiopatologia , Platibasia/diagnóstico por imagem , Platibasia/fisiopatologia , Platibasia/cirurgia
18.
Neuroimaging Clin N Am ; 29(2): 243-253, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30926114

RESUMO

Headache is a common symptom in patients with Chiari I malformation (CMI), characterized by 5 mm or greater cerebellar tonsillar herniation below foramen magnum. Radiologists should be aware of the different types of headaches reported by CMI patients and which headache patterns are distinctive features of the diagnosis. A methodical imaging strategy is required to fully assess a CMI patient to exclude secondary causes of tonsillar herniation such as intracranial hypotension or associated conditions such as syrinx. Both anatomic and physiologic imaging can help determine if headaches are CMI associated, and assist clinicians in therapeutic decision making.


Assuntos
Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/diagnóstico por imagem , Encéfalo/diagnóstico por imagem , Encéfalo/fisiopatologia , Cefaleia/etiologia , Imagem por Ressonância Magnética/métodos , Malformação de Arnold-Chiari/fisiopatologia , Humanos
20.
World Neurosurg ; 126: e641-e645, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30831298

RESUMO

OBJECTIVE: Adults with Chiari malformation type 1 (CM1) often report cognitive impairment. This cross-sectional study investigates the cognitive and emotional functioning of a sample of adults with CM1 who presented for neurosurgical evaluation prior to intervention. METHODS: A total of 36 participants (18 patients with CM1 and 18 healthy control subjects) completed a comprehensive neurocognitive battery of tests. RESULTS: Demographic variables (sex, age, handedness, and education) were not statistically significant between the groups. Measures of gross cognition (Mini-Mental State Examination and Repeatable Battery for the Assessment of Neuropsychological Status) were statistically significant between the groups. On a more focused assessment of neurocognitive abilities, the CM1 group performed significantly worse on measures of learning, memory, fluency, and figural copy. A high rate of clinical depression was seen in the CM1 group; however, this did not correlate with cognitive performance. CONCLUSIONS: The CM1 group displayed subtle learning, semantic fluency, and complex construction difficulties compared with healthy control subjects. Although not correlated with cognition, adults with CM1 are at high risk for clinical depression.


Assuntos
Malformação de Arnold-Chiari/complicações , Disfunção Cognitiva/etiologia , Adulto , Malformação de Arnold-Chiari/psicologia , Disfunção Cognitiva/epidemiologia , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Feminino , Humanos , Masculino
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