Chiari I Malformation: Clinical Presentation and Management

Strayer, Andrea

doi:10.1097/01376517-200104000-00005

Cited by 43 publications

(15 citation statements)

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“…An important limitation in our study, and one that begs discussion for all CM/SM studies in CKCS, is the difficulty in identifying a true "normal" population for comparison within the breed. While the importance of CM as a contributor to pain has been historically minimized in dogs with SM, it has been documented in both people and dogs to cause pain in the absence of SM [9,[25][26][27], with or without variable contribution from concurrent craniocervical junction anomalies [28][29][30]. Selection of CKCS without CM or other minor occipital or skull-based malformations proves near impossible due to the ubiquitous nature of these malformations within the breed [7,31].…”

Section: Discussionmentioning

confidence: 99%

Mechanical quantitative sensory testing in cavalier King Charles spaniels with and without syringomyelia

et al. 2020

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Background: Syringomyelia (SM) is a debilitating condition in the cavalier King Charles spaniel (CKCS) that results in neuropathic pain and diminished quality of life. Von Frey aesthesiometry (VFA) is a method of mechanical quantitative sensory testing that provides an objective sensory threshold (ST) value and can be used to quantify neuropathic pain (NP) and monitor response to therapy. The utility of VFA has been previously established in client-owned dogs with acute spinal cord injury but the technique has not been evaluated in dogs with SM. The goal of this study was to evaluate ST, as determined by VFA, in dogs with and without SM, to assess the utility of VFA in quantifying NP in SMaffected dogs. We hypothesized the SM-affected CKCS would have lower ST values, consistent with hyperesthesia, when compared to control CKCS. Additionally, we hypothesized that ST values in SM-affected dogs would be inversely correlated with syrinx size on MRI and with owner-derived clinical sign scores. Results: ST values for the thoracic and pelvic limbs differed significantly between the SM-affected and control CKCS (p = 0.027; p = 0.0396 respectively). Median ST value (range) for the thoracic limbs was 184.1 g (120.9-552) for control dogs, and 139.9 g (52.6-250.9) for SM-affected dogs. The median ST value (range) for the pelvic limbs was 164.9 g (100.8-260.3) in control dogs and 129.8 g (57.95-168.4) in SM-affected dogs. The ST values in SM-affected dogs did not correlate with syrinx height on MRI (r = 0.314; p = 0.137). Owner-reported clinical sign scores showed an inverse correlation with pelvic limb ST values, where dogs with lower ST values (hyperesthesia) were reported by their owners to display more frequent and severe clinical signs (r = − 0.657; p = 0.022). Conclusion: ST values were lower in SM-affected CKCS compared to control dogs, suggesting the presence of neuropathic pain. Dogs with lower ST pelvic limb values were perceived by their owners to have more severe clinical signs classically associated with SM. Our results suggest that VFA might offer quantitative assessment of neuropathic pain in SM-affected dogs and could be useful for monitoring response to therapy in future clinical studies.

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Section: Discussionmentioning

confidence: 99%

Mechanical quantitative sensory testing in cavalier King Charles spaniels with and without syringomyelia

et al. 2020

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“…The purpose of this surgery is to decompress the Chiari malformation by providing a space around the cerebellum and spinal cord. This results in decreased pressure and normal flow of the CSF (Strayer, 2001). The surgery lasted 8 hours with an estimated blood loss of 85 mL.…”

Section: Interventionmentioning

confidence: 99%

“…Chiari described type I malformation as elongated ("pegged") cerebellar tonsils, displaced into the upper cervical canal. Type I usually presents in young adulthood (Strayer, 2001). Arnold-Chiari malformation type I is thought to cause apnea by three possible mechanisms that are related to compression of the brainstem: "depression of the respiratory center, dysfunction of the ascending reticular activating system, or paralysis of movement in the upper respiratory wall including the vocal cord" (Shiihara, Shimizu, Mitsui, Saitoh, & Sato, 1995, p. 266).…”

Section: Introductionmentioning

confidence: 99%

“…Instructions include observing the incision site for any signs of drainage, redness, or tense fluid collection and observing the patient for severe headache, fever greater then 101.5°F, increased severe stiff neck, or lethargy. A follow-up MRI is usually done at 3 months (Dure et al, 1989;Nagib, 1994;Strayer, 2001). …”

Section: Introductionmentioning

confidence: 99%

“…However, with the increased use of magnetic resonance imaging (MRI), this craniocervical malformation is being identified earlier and often in asymptomatic patients before the onset of neurologic symptoms such as headache, neck pain, ataxia, sensory deficit, lower cranial nerve palsies, and nystagmus. Occulomotor disturbances, syncope, torticollis, paralysis, scoliosis, sleep apnea, and sudden death resulting from Arnold-Chiari type I malformation also have been reported (Ali, Russell, Awada, & McLean, 1996;Dure, Percy, Cheek, & Laurent, 1989;Strayer, 2001). …”

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confidence: 99%

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Arnold-Chiari malformation type I and sleep-disordered breathing: An uncommon manifestation of an important pediatric problem

Hershberger

Chidekel

2003

Journal of Pediatric Health Care

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A case review of a healthy 3-yearold toddler with a chief complaint of sleep-disordered breathing is presented. The child underwent a pneumogram sleep study with significant abnormal findings. Magnetic resonance imaging led to a diagnosis of Arnold-Chiari type I malformation and the need for posterior fossa decompression. The child has been monitored, and 1 year postoperatively, her sleep apnea has resolved and daytime function and development remain normal. Definitions of the different types of Arnold-Chiari malformation are discussed, with sleep apnea presenting as the only symptom. The importance of a sleep history as part of the practitioner's pediatric assessment is explored.

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Chiari Malformation and Syringomyelia

Pownall

2017

Nursing Care of the Pediatric Neurosurgery Patient

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Chiari I Malformation: Clinical Presentation and Management

Cited by 43 publications

References 0 publications

Mechanical quantitative sensory testing in cavalier King Charles spaniels with and without syringomyelia

Mechanical quantitative sensory testing in cavalier King Charles spaniels with and without syringomyelia

Arnold-Chiari malformation type I and sleep-disordered breathing: An uncommon manifestation of an important pediatric problem

Chiari Malformation and Syringomyelia

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