Sleep disturbance: A forgotten syndrome in patients with Chiari I malformation

Ferré, Àlex; Poca, M.A.; Calzada, M.D. de la; Solana, E.; Tomás, Odile Romero Santo; Sahuquillo, J.

doi:10.1016/j.nrleng.2010.12.011

Cited by 8 publications

(11 citation statements)

References 64 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…One comorbidity that was not fully investigated in this retrospective study was whether sleep apnea could be a complicating factor. Patients with CM1 are predisposed to sleep disorders and have a high prevalence of sleep apnea‐hypopnea syndrome . Cavalier King Charles spaniels are also predisposed to BOAS, and although an attempt was made to exclude these dogs, none of the dogs with sleep disruption had whole‐body barometric plethysmography …”

Section: Discussionmentioning

confidence: 99%

Behavioral and clinical signs of Chiari‐like malformation‐associated pain and syringomyelia in Cavalier King Charles spaniels

Rusbridge

McFadyen²,

Knower

2019

Veterinary Internal Medicne

View full text Add to dashboard Cite

Background Diagnosis of Chiari‐like malformation‐associated pain (CM‐P) or clinically relevant syringomyelia (SM) is challenging. We sought to determine common signs. Animals One hundred thirty client‐owned Cavalier King Charles spaniels with neuroaxis magnetic resonance imaging (MRI) and diagnosis of CM‐P/SM. Dogs with comorbidities causing similar signs were excluded with exception of otitis media with effusion (OME). Methods Retrospective study of medical records relating signalment, signs, and MRI findings. Dogs were grouped by SM maximum transverse diameter (1 = no SM; 2 = 0.5‐1.99 mm; 3 = 2‐3.9 mm: 4 = ≥4 mm). Differences between all groups—groups 1 versus 2‐4 and groups 1‐3 versus 4—were investigated. Continuous variables were analyzed using 2‐sample t‐tests and analysis of variance. Associations between categorical variables were analyzed using Fisher's exact or chi‐square tests. Results Common signs were vocalization (65.4%), spinal pain (54.6%), reduced activity (37.7%), reduced stairs/jumping ability (35.4%), touch aversion (30.0%), altered emotional state (28.5%), and sleep disturbance (22%). Head scratching/rubbing (28.5%) was inversely associated with syrinx size (P = .005), less common in group 4 (P = .003), and not associated with OME (P = .977). Phantom scratching, scoliosis, weakness, and postural deficits were only seen in group 4 (SM ≥4 mm; P = .004). Conclusions and Clinical Importance Signs of pain are common in CM/SM but are not SM‐dependent, suggesting (not proving) CM‐P causality. Wide (≥4 mm) SM is associated with signs of myelopathy and, if the dorsal horn is involved, phantom scratching (ipsilateral) and torticollis (shoulder deviated ipsilateral; head tilt contralateral).

show abstract

Section: Discussionmentioning

confidence: 99%

Behavioral and clinical signs of Chiari‐like malformation‐associated pain and syringomyelia in Cavalier King Charles spaniels

Rusbridge

McFadyen²,

Knower

2019

Veterinary Internal Medicne

View full text Add to dashboard Cite

show abstract

“…In 1998, BAEPs and SSEPs were in-troduced into the routine workup, and whole-night polysomnography for the detection of covert sleep disorders was incorporated into the protocol in 2006. 16 In surgical candidates, a CT angiogram is also routinely conducted to detect arterial and venous abnormalities of the CVJ.…”

Section: Methodsmentioning

confidence: 99%

“…Many of these patients present with significant alterations in sleep, a pattern of severe sleep apnea-hypopnea syndromes, and even respiratory failure. 7,16 A second group to be concerned about is oligosymptomatic/asymptomatic patients with an incidentally detected syrinx. In this group, the degree of tonsillar herniation is a poor predictor of whether these patients will experience clinical progression and if the risk-to-benefit ratio of surgery is acceptable compared with the natural evolution of the disease.…”

mentioning

confidence: 99%

Are evoked potentials clinically useful in the study of patients with Chiari malformation Type 1?

Moncho

Poca

Minoves³

et al. 2017

JNS

View full text Add to dashboard Cite

OBJECTIVE In this study, the authors describe the brainstem auditory evoked potential (BAEP) and somatosensory evoked potential (SSEP) alterations found in a large cohort of patients with Chiari malformation Type 1 (CM-1), the relationship between the BAEPs/SSEPs and the clinical findings, the abnormalities in patients with associated syringomyelia, and the clinical and neuroradiological risk factors that are associated with abnormal evoked potentials (EPs). METHODS A prospectively collected database containing 545 patients with CM-1 was queried to search for patients satisfying the following criteria: 1) an age of at least 14 years, 2) neuroradiological criteria of CM-1, 3) no prior Chiari-related surgeries, and 4) preoperative EP studies conducted at the authors' institution. The 200 patients included in this cohort were classified into CM-0, CM-1, and CM-1.5 subtypes. Linear, planimetric, and angular measurements of the posterior fossa were conducted, as well as syringomyelia measurements. Two separate multiple logistic regression models were used, one to predict the covariates associated with abnormal BAEPs, and a second model to explore the variables associated with an abnormal SSEP. In these models, the BAEPs and SSEPs were dichotomized as being normal or abnormal. RESULTS Headaches were the main symptom in 70.5% of the patients, and Valsalva-induced headaches were most frequent in patients with CM-1 and CM-1.5 compared with patients with CM-0 (p = 0.031). BAEPs were abnormal in 38.5% of patients, and abnormal SSEPs were found in 43.5% of the entire cohort. Syringomyelia was most frequent in patients with CM-0 (64.3%) and CM-1 (51.1%) compared with those with CM-1.5 (34.7%; p = 0.03). Age (OR 1.03, 95% CI 1.00-1.06), the degree of tonsillar herniation (OR 1.08, 95% CI 1.01-1.16), and lower cranial nerve dysfunction (OR 3.99, 95% CI 1.29-14.01) had a statistically significant correlation with abnormal BAEPs. Only age (OR 1.07, 95% CI 1.04-1.10) and the degree of tonsillar herniation (OR 1.11, 95% CI 1.04-1.19) had a statistically significant correlation with abnormal SSEPs. CONCLUSIONS A high percentage of patients with CM-1 exhibited EP alterations regardless of their clinical or radiological findings. These findings suggest that EPs do not add any clinically relevant information nor are they helpful in establishing which symptomatic patients with CM should undergo surgical treatment. However, BAEP and SSEP studies clearly play an important role in incidentally detected patients with CM and may help to establish objective evidence of subclinical dysfunctions. In addition, neurophysiological studies may help to define subgroups of patients who require further testing and follow-up to personalize strategies for the management of incidental and oligosymptomatic patients.

show abstract

“…Cada ítem tiene cuatro posibles respuestas, que se puntúan de 0 a 3. Las puntuaciones obtenidas pueden oscilar entre 0 y 63 puntos, permitiendo objetivar la ausencia de la depresión (0-9 puntos) y, cuando existe, clasificar su gravedad en tres categorías: leve (10)(11)(12)(13)(14)(15)(16)(17)(18), moderada (19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) o grave (30-63 puntos). de cisterna magna y siringomielia, por lo que podrían incluirse dentro de la categoría de Chiari 0 propuesta por algunos autores [30].…”

Section: Depresión (Inventario De Depresión De Beck)unclassified

“…El síntoma más común es la cefalea de localización occipitonucal, que aumenta con las maniobras de Valsalva. Otros síntomas asociados a la MC-I son: dolor cervical, parestesias, déficits motores, debilidad, cansancio, vértigo, irritabilidad, tinnitus, disfagia o trastornos respiratorios nocturnos (síndrome de apnea-hipopnea durante el sueño) [10][11][12]. Los pacientes con una MC-I aislada oligo o asintomáticos, cuyo diagnóstico se realiza de forma incidental, deben ser estudiados y seguidos clínicamente.…”

Section: Introductionunclassified

Evaluación de la calidad de vida en los pacientes con una malformación de Chiari tipo I. Estudio piloto en una cohorte de 67 pacientes

Mestres

Poca²,

Solana³

et al. 2012

RevNeurol

View full text Add to dashboard Cite

Introducción. La malformación de Chiari tipo I (MC-I) es una entidad de baja prevalencia, cuya clínica es muy variada dependiendo del cortejo malformativo asociado, y en la que pueden existir síntomas ansiosodepresivos y una pérdida no definida de la calidad de vida de los pacientes. El objetivo principal de este estudio es determinar la repercusión de la MC-I en la calidad de vida, así como la presencia de ansiedad y depresión en estos pacientes. Pacientes y métodos. Estudio prospectivo de una cohorte de 67 pacientes afectos de MC-I en los que se valoraron la calidad de vida, la presencia de ansiedad y síntomas depresivos mediante las escalas Sickness Impact Profile, inventario de ansiedad estado-rasgo e inventario de depresión de Beck, respectivamente. En cada paciente se registró la presencia de siringomielia o hidrocefalia, así como el grado de ectopia de las amígdalas del cerebelo. Resultados. El impacto de la MC-I en la calidad de vida fue nulo en seis pacientes (9%), leve en 36 (53,7%), moderado en 17 (25,4%) y grave en ocho (11,9%). El área de actividad más afectada fue el trabajo. El 86,6% de los pacientes presentó un nivel de ansiedad moderado o elevado. En el 25,4% de los pacientes también se constataron síntomas depresivos moderados o graves. Conclusiones. La gran mayoría de los pacientes con una MC-I considera que su enfermedad implica una pérdida de calidad de vida que, en muchos casos, se asocia a una alta ansiedad y a síntomas depresivos. Palabras clave. Ansiedad. Calidad de vida. Depresión. Ectopia amigdalar. Hidrocefalia. Malformación de Chiari tipo I. Siringomielia.

show abstract

Sleep disturbance: A forgotten syndrome in patients with Chiari I malformation

Cited by 8 publications

References 64 publications

Behavioral and clinical signs of Chiari‐like malformation‐associated pain and syringomyelia in Cavalier King Charles spaniels

Behavioral and clinical signs of Chiari‐like malformation‐associated pain and syringomyelia in Cavalier King Charles spaniels

Are evoked potentials clinically useful in the study of patients with Chiari malformation Type 1?

Evaluación de la calidad de vida en los pacientes con una malformación de Chiari tipo I. Estudio piloto en una cohorte de 67 pacientes

Contact Info

Product

Resources

About