Cerebrospinal Fluid Flow Impedance is Elevated in Type I Chiari Malformation

Autor: Nicholas Shaffer, Casey Madura, John N. Oshinski, Bryn A. Martin, Brandon G. Rocque, Bermans J. Iskandar, Mark G. Luciano, Oliver Wieben, Stephen M. Dombrowski, Francis Loth
Jazyk: angličtina
Rok vydání: 2014
Předmět:
Popis: Type I Chiari malformation (CMI) is a complex disorder of the craniospinal system that has historically been radiologically defined by cerebellar tonsillar herniation (CTH) greater than 3–5 mm below the foramen magnum (FM) into the spinal subarachnoid space (SSS) (Fig. ​(Fig.11 ) [1–3]. Patients with CMI can have a variety of neurological symptoms and pain ranging from mild to severe [1]. It is thought that these symptoms result from abnormal pressure acting on the spinal cord, brain stem, and/or cerebellum due to crowding of the tissue in the posterior cranial fossa and craniovertebral junction (CVJ) [4–6]. However, large retrospective clinical studies have shown that CMI symptom severity does not always correlate with CTH depth [7]. Patients with large CTH may present with mild neurological symptoms and vice versa [6]. Fig. 1 (a) Midsagittal MRI image of the cervical spine of a CMI patient showing the McRae line, CTH measurement (approximately 7.4 mm for this case), and planes where pressure drop was calculated; (b) transverse MRI image from the plane used to demarcate ... As such, clinicians have sought additional objective measurements to assist in the diagnostic process. In clinical practice, the diagnostic process can vary widely; clinicians have differing views on the importance of CTH alongside many factors such as symptom history, neurologic deficit, degree of craniocervical “crowding” bony landmark positions, and cisterna magna volume. CTH greater than 3–5 mm as a marker for CMI has been established as a ‘rule of thumb’ over time. This is problematic, as incidental observation of CTH has become more common with increases in the use of magnetic resonance imaging (MRI) for head and neck injury examinations. Recent research has shown that as much as 3% of the pediatric population, 2% of the adult female population, and 1% of the adult male population have greater than 5 mm CTH [8,9] and CTH varies throughout life (Fig. ​(Fig.22). Fig. 2 CTH as a function of age (in decade range, e.g., first decade 0–10 y) and sex for healthy subjects showing a parabolic trend with females having greater CTH values throughout life. Positive CTH values are in the caudal direction to the ...
Databáze: OpenAIRE