Difference between revisions of "Chiari malformation"
From WikiAnesthesia
Chris Rishel (talk | contribs) m (Chris.Rishel moved page Arnold Chiari Malformation/Posterior Craniotomy to Chiari malformation without leaving a redirect: Title style) |
Chris Rishel (talk | contribs) |
||
Line 1: | Line 1: | ||
{{Infobox comorbidity | |||
* Type I: | | other_names = | ||
* Type II: | | anesthetic_relevance = Moderate | ||
* Type III: Herniation of cerebellum, brain stem and possibly the fourth ventricle through the foramen magnum | | anesthetic_management = Avoid increased ICP | ||
* Type IV: | | specialty = Neurology | ||
- | | signs_symptoms = | ||
| diagnosis = | |||
| treatment = Surgical decompression | |||
| image = | |||
| caption = | |||
}} | |||
A '''Chiari malformation''' is an elongated cerebellar vermis that herniates through the foramen magnum, compressing the brain stem. Chiari malformations are classified as Type I-IV based upon on the extent of herniation. | |||
==Anesthetic implications<!-- Briefly summarize the anesthetic implications of this comorbidity. -->== | |||
===Preoperative optimization<!-- Describe how this comorbidity may influence preoperative evaluation and optimization of patients. -->=== | |||
===Intraoperative management<!-- Describe how this comorbidity may influence intraoperative management. -->=== | |||
* Avoid increased ICP | |||
===Postoperative management<!-- Describe how this comorbidity may influence postoperative management. -->=== | |||
==Related surgical procedures<!-- List and briefly describe any procedures which may be performed specifically to treat this comorbidity or its sequelae. If none, this section may be removed. -->== | |||
* [[Craniocervical decompression]] | |||
==Pathophysiology<!-- Describe the pathophysiology of this comorbidity. Add subsections as needed. -->== | |||
*Type I: Only the cerebellar tonsils extend into the foramen magnum | |||
**Most common, may be asymptomatic | |||
* Type II: Cerebellar tonsils and brainstem tissue extend into foramen magnum | |||
**Also known as an Arnold-Chiari malformation | |||
**Associated with myelomeningocele | |||
*Type III: Herniation of cerebellum, brain stem and possibly the fourth ventricle through the foramen magnum | |||
*Type IV: Cerebellar hypoplasia | |||
**Typically does not survive past infancy | |||
==Signs and symptoms<!-- Describe the signs and symptoms of this comorbidity. -->== | |||
* Headache (especially after valsalva) | |||
* Neck Pain | |||
* Balance problems | |||
* Weakness | |||
* Decreased sensation | |||
Common pediatric presentations include: | |||
* Dysphagia | |||
* Recurrent aspiration | |||
* Stridor | |||
* Apneic episodes | |||
* Lack of gag reflex | |||
* Often associated with syringomyelia and therefore arm weakness and sensory deficits | |||
==Diagnosis<!-- Describe how this comorbidity is diagnosed. -->== | |||
* MRI | |||
==Treatment<!-- Summarize the treatment of this comorbidity. Add subsections as needed. -->== | |||
===Surgery<!-- Describe surgical procedures used to treat this comorbidity. -->=== | |||
* Chiari malformations can be surgically treated with a [[craniocervical decompression]] | |||
* Type I Chiari malformations may be asymptomatic and not require treatment | |||
* The timing of surgery depends on the severity of the malformation and associated symptoms | |||
===Prognosis<!-- Describe the prognosis of this comorbidity -->=== | |||
* Variable depending on the severity of the malformation and the success of surgery | |||
==Epidemiology<!-- Describe the epidemiology of this comorbidity -->== | |||
==References== | |||
[[Category:Comorbidities]] | |||
[[Category:Neurologic disorders]] |
Latest revision as of 13:29, 24 July 2022
Chiari malformation
Anesthetic relevance |
Moderate |
---|---|
Anesthetic management |
Avoid increased ICP |
Specialty |
Neurology |
Signs and symptoms | |
Diagnosis | |
Treatment |
Surgical decompression |
Article quality | |
Editor rating | |
User likes | 0 |
A Chiari malformation is an elongated cerebellar vermis that herniates through the foramen magnum, compressing the brain stem. Chiari malformations are classified as Type I-IV based upon on the extent of herniation.
Anesthetic implications
Preoperative optimization
Intraoperative management
- Avoid increased ICP
Postoperative management
Related surgical procedures
Pathophysiology
- Type I: Only the cerebellar tonsils extend into the foramen magnum
- Most common, may be asymptomatic
- Type II: Cerebellar tonsils and brainstem tissue extend into foramen magnum
- Also known as an Arnold-Chiari malformation
- Associated with myelomeningocele
- Type III: Herniation of cerebellum, brain stem and possibly the fourth ventricle through the foramen magnum
- Type IV: Cerebellar hypoplasia
- Typically does not survive past infancy
Signs and symptoms
- Headache (especially after valsalva)
- Neck Pain
- Balance problems
- Weakness
- Decreased sensation
Common pediatric presentations include:
- Dysphagia
- Recurrent aspiration
- Stridor
- Apneic episodes
- Lack of gag reflex
- Often associated with syringomyelia and therefore arm weakness and sensory deficits
Diagnosis
- MRI
Treatment
Surgery
- Chiari malformations can be surgically treated with a craniocervical decompression
- Type I Chiari malformations may be asymptomatic and not require treatment
- The timing of surgery depends on the severity of the malformation and associated symptoms
Prognosis
- Variable depending on the severity of the malformation and the success of surgery
Epidemiology
References
Top contributors: Chris Rishel and Alexandra Ioannou