What should be the delivery mode a pregnant women with Chiari type I malformation who has severe cerebellar herniation : a case report

Year 2015, Volume: 5 Issue: 2, 0 - 0, 01.06.2015

Keziban Doğan

Abstract

Abstract

Chiari type I malformation which is characterized by cerebellar herniation is a  congenital anomaly that can be diagnosed by magnetic resonance imaging. Most common  symptoms  are  headache, neck and extremity pain, hypoesthesia and weakness  especially  in the upper  extremities. The suitable mode of delivery and anesthesia for the pregnant patients with Chiari type I malformation is controversial. In this paper, we  present a case of  37 weeks of gestation of a pregnant woman with  Chiari type I malformation who had severe herniation of cerebellum and  gave the birth by cesarean section with general anesthesia. We  aimed  to discuss about the suitable mode of delivery and anesthesia  for each patient with Chiari type I malformation with multidisciplinary approach .

Key words:  Chiari type I malformation, pregnancy, delivery mode, anesthesia

İleri düzeyde serebellar herniasyonu olan Chiari tip I  malformasyonlu gebe bir kadının doğum şekli ne olmalıdır: Olgu sunumu

Özet

Chiari tip I  malformasyonu; serebellar herniasyon ile karakterize magnetik resonans görüntüleme ile tanı konulabilen konjenital bir anomalidir.En sık görülen semptomlar; baş, boyun ve extremite ağrısı, özellikle üst ekstremitelerde görülen hipoestezi ve güçsüzlüktür. Chiari tip I  malformasyonlu gebe kadınlar için uygun doğum ve anestezi yöntemi hala tartışmalıdır. Biz bu makalede genel anestezi altında sezeryan ile doğurttuğumuz Chiari tip I  malformasyonlu, ileri derecede serebellar herniasyonu olan bir olguyu sunduk. Multidisipliner bir yaklaşımla bu hastalar için uygun doğum ve anestezi yöntemini tartışmayı amaçladık.

Anahtar kelimeler: Chiari tip I  malformasyonu, gebelik, doğum şekli, anestezi yöntemi

 

References

• References
• Sarnat HB. Disorders of segmentation of the neural tube: Chiari malformations. Handb Clin Neurol 2008; 87: 89-103.
• Choi CK, Tyagaraj K. Combined spinal-epidural analgesia for laboring parturient with Arnold-Chiari type I malformation: a case report and a review of the literature. Case Rep Anesthesiol 2013; 2013: 512915.
• Newhouse BJ, Kuczhowski KM. Uneventful epidural labor analgesia and vaginal delivery in a parturient with Arnold-Chiari malformation type I and sickle cell disease. Arch of Gynecol Obstet 2007; 275: 311-3.
• Nielsen JL, Bejjani GK, Vallejo MC. Cesarean delivery in a parturient with syringomyelia and worsening neurological symptoms. J Clin Anesth 2011; 23: 653-6.
• Hönemann C, Moormann S, Hagemann O, Doll D. Spinal anesthesia for cesarean delivery in a patient with syringomyelia. Int J Gynaecol Obstet 2014; 125: 172-4.
• Barton JJ, Sharpe JA. Oscillopsia and horizontal nystagmus with accelerating slow phases following lumbar puncture in the Arnold-Chiari Malformation. Ann Neurol 1993; 33: 418-21.
• Ghaly RF, Candido KD, Suer R, Knezevic NN. Anesthetic management during Cesarean section in a woman with residual Arnold-Chiari malformation Type I, cervical kyphosis, and syringomyelia. Surg Neurol Int 2012; 3: 26.
• Chantigian RC, Koehn MA, Ramin KD, Warner MA. Chiari I malformation in parturients. J Clin Anesth 2002; 14(3): 201-5.
• Hopkins AN, Alshaeri T, Akst SA, Berger JS. Neurologic disease with pregnancy and considerations fort he obstetric anesthesiologist. Semin Perinatol 2014; 38: 359-69.
• Hullander RM, Bogard TD, Leivers D, Moran D, Dewan DM. Chiari I malformation presenting as recurrent spinal headache. Anesth Analg 1992; 75: 1025-6.