Protracted respiratory failure in a case of global spinal syringomyelia and Chiari malformation following administration of diazepam: illustrative case.

Autor:	Bauerle L; 1College of Medicine, Medical University of South Carolina, Charleston, South Carolina., Rogowski B; 2Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania., Shingala A; 3Department of General Surgery, Sidney Kimmel Medical College, Philadelphia, Pennsylvania., Rafka HE; 1College of Medicine, Medical University of South Carolina, Charleston, South Carolina., Webb T; 4Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina., Saway BF; 4Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina., Kilb EF; 5Department of Medicine, Division of Pulmonary, Critical Care, Allergy, and Sleep, Medical University of South Carolina, Charleston, South Carolina., Chalela JA; 4Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina., Rowland NC; 4Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina.; 6Ralph Johnson VA Medical Center, Charleston, South Carolina.; 7Department of Neurosciences, Medical University of South Carolina, Charleston, South Carolina; and.; 8MUSC Institute for Neuroscience Discovery (MIND), Medical University of South Carolina, Charleston, South Carolina.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Case lessons [J Neurosurg Case Lessons] 2023 Nov 20; Vol. 6 (21). Date of Electronic Publication: 2023 Nov 20 (Print Publication: 2023).
DOI:	10.3171/CASE23449
Abstrakt:	Background: Syringomyelia is defined as dilation of the spinal cord's central canal and is often precipitated by skull base herniation disorders. Although respiratory failure (RF) can be associated with skull base abnormalities due to brainstem compression, most cases occur in pediatric patients and quickly resolve. The authors report the case of an adult patient with global spinal syringomyelia and Chiari malformation who developed refractory RF after routine administration of diazepam. Observations: A 31-year-old female presented with malnutrition, a 1-month history of right-sided weakness, and normal respiratory dynamics. After administration of diazepam prior to magnetic resonance imaging (MRI), she suddenly developed hypercapnic RF followed MRI and required intubation. MRI disclosed a Chiari malformation type I and syrinx extending from C1 to the conus medullaris. After decompressive surgery, her respiratory function progressively returned to baseline status, although 22 months after initial benzodiazepine administration, the patient continues to require nocturnal ventilation. Lessons: Administration of central nervous system depressants should be closely monitored in patients with extensive syrinx formation given the potential to exacerbate diminished central respiratory drive. Early identification of syrinx in the context of Chiari malformation and hemiplegia should prompt clinical suspicion of underlying respiratory compromise and early involvement of intensive care consultants.
Databáze:	MEDLINE
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