Difference between revisions of "Chiari malformation"

Chiari malformation
Anesthetic relevance	Moderate
Anesthetic management	Avoid increased ICP
Specialty	Neurology
Signs and symptoms
Diagnosis
Treatment	Surgical decompression
	Article quality
Editor rating	In development
User likes	0

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Latest revision as of 14:29, 24 July 2022

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

Craniocervical decompression

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

@@ Line 1: / Line 1: @@
-* The Arnold Chiari Malformation is an elongated cerebellar vermis that herniates through the foramen magnum, compressing the brain stem.
+{{Infobox comorbidity
-* Type I: only the cerebellar tonsils extend into the foramen magnum (most common, may be asymptomatic adult)
+| other_names =
-* Type II: cerebellar tonsils and brainstem tissue extend into foramen magnum. Associated with myelomeningocele.
+| 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: cerebellar hypoplasia
+| specialty = Neurology
--Type III and IV are less common but much more serious.
+| signs_symptoms =
--Common pediatric presentations including swallowing difficulty, recurrent aspiration, stridor, apneic episodes, and lack of gag reflex
+| diagnosis =
--Often associated with syringomyelia and therefore arm weakness and sensory deficits
+| 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]]