DOCSLIB.ORG

Management of Basilar Invagination Tratamento De Invaginação Basilar Andrei Fernandes Joaquim1, MD, Phd

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Management of Basilar Invagination Tratamento De Invaginação Basilar Andrei Fernandes Joaquim1, MD, Phd 53 Review Management of Basilar Invagination Tratamento de Invaginação Basilar Andrei Fernandes Joaquim1, MD, PhD. RESUMO A invaginação basilar (IB) constitui-se de uma anomalia do desenvolvimento da região crânio-cervical que resulta no prolapso da coluna cervical superior na base do crânio, comumente associada com outras anormalidades do neuro-eixo, tais como malformação de Chiari do tipo I e siringomielia. Neste artigo, revisamos os conceitos necessários para entender e tratar os pacientes com IB. O tratamento é discutido com base na classificação proposta por Goel, que divide a IB em dois grupos: grupo A - pacientes com elementos de instabilidade na junção crânio-cervical e grupo B - pacientes com IB secundária à hipoplasia do clivus. O tratamento no grupo A consiste no realinhamento e na estabilização da junção crânio-cervical, muitas vezes através de uma abordagem por via posterior isolada, evitando a morbidade inerente às descompressões por via anterior. No grupo B, a descompressão do forame magno é o tratamento de escolha. As técnicas cirúrgicas a serem utilizadas dependem da anatomia do paciente e da experiência do cirurgião. Resultados cirúrgicos adequados podem ser obtidos com o entendimento dos conceitos e formas de tratamento das diferentes apresentações da IB. Palavras Chave: invaginação basilar, classificação, tratamento. ABSTRACT Basilar invagination (BI) is a development anomaly of the craniocervical junction that results in a prolapsed of the upper cervical spine into the skull base, commonly associated to other bone and neural axis abnormalities, like Chiari I malformation and syringomyelia. In this paper, we review the concepts necessary to understand and treat BI. The most comprehensive and accepted classification system is the proposed by Goel, which divides patients with BI into two groups, as it follows: group A) patients with clear elements of instability; and group B) BI secondary to clivus hypoplasia. Treatment in group A includes craniocervical realignment and stabilization, most of the times using an isolated posterior approach, obviating an unnecessary and morbidity of the anterior decompression. In group B, foramen magnum decompression is the treatment of choice. Surgical techniques should be adequate according to patient’s anatomy and surgeon’s experience. Good surgical results can be obtained with the understanding of the main concepts and treatment options of BI. Keywords: basilar invagination, classification, diagnosis, surgical treatment. understand and treat BI based on its classification and the INTRODUCTION different surgical strategies adopted to treat this challenge and complex anomaly. Basilar invagination (BI) is a radiographic finding that consists in a development anomaly of the craniocervical junction in which the odontoid process is at least 2 mm above Chamberlain’s line (although up to 6.6 mm has been advocated as the normal MATERIAL AND METHODS limit), resulting in a prolapse of the upper cervical spine into the skull base6,10,24. Bone anomalies can cause or be associated A systematic review of the literature using the MedLine with BI. The most commonly findings are clivus hypoplasia, Database (National Library of Medicine), covering the period condyle hypoplasia, anomalies of the atlas formation and from 1980 to 2012, was performed. The search strategy atlanto-occipital assimilation24,25,26. In addition, about 30% of involved the keywords “basilar invagination treatment”. the patients with BI have also neural axis abnormalities, like Inclusion criteria included English language (or translated Chiari malformation, syringomyelia and hydrocephalus30. text), diagnosis of basilar invagination, discussion about management and surgical treatment of this entity. No age In this paper, we review the basic concepts necessary to 1Assistant Neurosurgeon – Neurosurgery Division, State University of Campinas (UNICAMP), Campinas-SP. Brazil and Centro Infantil Boldrini, Campinas-SP. Received, Apr 25, 2012. Accepted, Oct 08, 2013 Joaquim AF. - Management of Basilar Invagination J Bras Neurocirurg 24 (1): 53-59, 2013 54 Review restrictions were included. All case series, clinical studies and review articles were also included. In addition, a manual search of all referenced articles not found in the search was performed. 315 articles were initially found. Cross references of classic historical articles were also included. We excluded some articles based on repeated information for the purpose of our review. After all abstracts were screened, 31 articles were evaluated and included in our review. Basic craniocervical craniometry (figure 1) Some basic craniocervical craniometrical concepts are necessary to diagnosis, understand and treat BI. A brief review Figure 1: A – In B, we have the Basion (full arrow) and in O the opisthion (dash arrow). B – The Chamberlain Line, C- The McRae line defining the plane of the of the main craniometrical points is exposed, as it follows: foramen magnum and D- The Wackenheim Clivus Baseline or Basilar line (full line), that forms part of the clivus-canal angle if we add an additional line (dash line) that Basion – it refers to the anterior margin of the foramen passes along the posterior body of the axis. magnum24. Opisthion – it refers to the posterior margin of the foramen Craniocervical junction – anatomic anomalies of clinical magnum24. importance in the treatment of bi McRae line – defines the plan of the foramen magnum. It is Some anatomic development anomalies are associated with BI. formed by a line from the basion to the opisthion. The tip of the The most important are presented below: odontoid process should be fall below this line24. Atlantooccipital Assimilation - assimilation of the atlas is Platybasia – this term refers to a flattening of the skull base. caused by a failure of segmentation between the skull and It can be associated to BI but also may present in isolation23. the first cervical vertebra, completely or partially. Although The diagnosis of platybasia is made based on the measurement the Wackenheim clivus baseline may be normal, the clivus- of the Welcher Basal Angle24. This angle is defined by a line canal angle may be decreased. It’s commonly associated with extended from the nasium to the anterior tubercullum sellae fusion of the axis and third cervical vertebra. This association and other from this last to the basion. In normal subjects, it (atlantooccipital assimilation and axis-C3 fusion) is associated 26 should be less than 140o. Patients with increasing in this angle with atlantoaxial subluxation in about 50% of the cases . had the diagnosis of platybasia. Basilar impression – it refers to the acquired form of BI Wackenheim Clivus Baseline or Basilar line – this is a line secondary to softening of the bone and joints at the base of the along the clivus extending inferiorly into the upper cervical skull. The main etiologies include rheumatoid arthritis, Paget 24,25 spine canal. It should fall tangent to the posterior aspect disease, infection, tumors, among others . This term was of the tip of the odontoid process. The angle formed by the proposed by Virchow, in 1876, 19 years later of the introduction 27,28 intersection of the line constructed along the posterior surface of the term platybasia . of the axis body and the Wackenhein clivus baseline is called as Basiocciput (clivus) Hypoplasia – represents the hypoplasia of craniovertebral or clivus-canal angle. It normally ranges from the basiocciput that results in shortening of the clivus and BI 150o to 180o, changing about 30o with flexion and extension (violation of the Chamberlain line by the tip of the odontoid), positions24,26,29. Craniocervical kyphosis can be attributed when decreasing the clivus-canal angle and producing cranio-cervical the clivus-canal angle is less than 150o. kyphosis, resulting in deformity at the cervicomedullary junction26. Basion – it refers to the anterior margin of the foramen Joaquim AF. - Management of Basilar Invagination J Bras Neurocirurg 24 (1): 53-59, 2013 55 Review magnum24. Condylar Hypoplasia - The underdevelopment of the occipital CLASSIFICATION OF BI condyles, with a flattened appearance, leads to basilar Goel proposed a classification of BI based on the presence invagination, secondary to violation of the Chamberlain line or absence of clinical and radiological instability12. This and widening of the atlantooccipital joint axis angle. The tip classification is important once it can help surgeons in to of the odontoid process and the lateral masses of the atlas lie decide the best form of surgical treatment: below the McRae line. The lateral mass of the atlas may be fused to the hypoplastic condyles, accentuating the BI and Group A – This group main characteristic is the presence of limiting the movements of the atlantoccipital joint24. a clear instability of the region manifested by the tip of the odontoid process distancing itself from the anterior arch of the Chiari Type I Malformation – a caudal rhombencephalon atlas or the lower end of the clivus. A case example of BI of this abnormality that it is represented by a downward displacement group is presented in Figure 2 and 4. of the cerebellar tonsils and the medial portions of the inferior cerebellar lobes into the cervical spinal canal7,8. Symptoms Diagnostic criteria: are secondary to valve effect by the protruding tonsils at the - atlantoaxial dislocation (generally with C1-2 subluxation) foramen magnum or direct compression of nervous tissue. - tip of the odontoid process
Load more

Recommended publications
  • The Chiari Malformations *
    J Neurol Neurosurg Psychiatry: first published as 10.1136/jnnp.72.suppl_2.ii38 on 1 June 2002. Downloaded from THE CHIARI MALFORMATIONS Donald M Hadley ii38* J Neurol Neurosurg Psychiatry 2002;72(Suppl II):ii38–ii40 r Hans Chiari1 first described three hindbrain disorders associated with hydrocephalus in 1891. They have neither an anatomical nor embryological correlation with each other, but Dthey all involve the cerebellum and spinal cord and are thought to belong to the group of abnormalities that result from failure of normal dorsal induction. These include neural tube defects, cephaloceles, and spinal dysraphic abnormalities. Symptoms range from headache, sensory changes, vertigo, limb weakness, ataxia and imbalance to hearing loss. Only those with a type I Chiari malformation may be born grossly normal. The abnormalities are best shown on midline sagittal T1 weighted magnetic resonance imaging (MRI),2 but suspicious features on routine axial computed tomographic brain scans (an abnormal IVth ventricle, a “full” foramen magnum, and absent cisterna magna) should be recognised and followed up with MRI. c CHIARI I This is the mildest of the hindbrain malformations and is characterised by displacement of deformed cerebellar tonsils more than 5 mm caudally through the foramen magnum.3 The brain- stem and IVth ventricle retain a relatively normal position although the IVth ventricle may be small copyright. and slightly distorted (fig 1). A number of subgroups have been defined. c In the first group, intrauterine hydrocephalus causes tonsillar herniation. Once myelinated the tonsils retain this pointed configuration and ectopic position. Patients tend to present in child- hood with hydrocephalus and usually with syringomyelia.
    [Show full text]
  • Basilar Invagination: Case Report and Literature Review
    Accepted Manuscript Basilar Invagination: Case Report and Literature Review Nauman S. Chaudhry, MD, Alp Ozpinar, BS, Wenya Linda Bi, MD, PhD, Vamsidhar Chavakula, MD, John H. Chi, MD, MPH, Ian F. Dunn, MD PII: S1878-8750(15)00084-4 DOI: 10.1016/j.wneu.2015.02.007 Reference: WNEU 2716 To appear in: World Neurosurgery Please cite this article as: Chaudhry NS, Ozpinar A, Bi WL, Chavakula V, Chi JH, Dunn IF, Basilar Invagination: Case Report and Literature Review, World Neurosurgery (2015), doi: 10.1016/ j.wneu.2015.02.007. This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. ACCEPTED MANUSCRIPT Basilar Invagination: Case Report and Literature Review Nauman S. Chaudhry, MD1*, Alp Ozpinar, BS2*, Wenya Linda Bi, MD, PhD1, Vamsidhar Chavakula, MD1, John H. Chi, MD, MPH1, Ian F. Dunn, MD1 1Department of Neurosurgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 2Department of Neurological Surgery, Oregon Health Sciences University, Portland, OR *These authors contributed equally Please address all correspondence to: Ian F. Dunn, M.D. Department of Neurosurgery Brigham and Women’s Hospital 15 Francis Street, PBB-3 Boston, MA 02115 Phone: 617-525-8371 Email: [email protected] Running Title: Anterior vs.
    [Show full text]
  • Pushing the Limits of Prenatal Ultrasound: a Case of Dorsal Dermal Sinus Associated with an Overt Arnold–Chiari Malformation and a 3Q Duplication
    reproductive medicine Case Report Pushing the Limits of Prenatal Ultrasound: A Case of Dorsal Dermal Sinus Associated with an Overt Arnold–Chiari Malformation and a 3q Duplication Olivier Leroij 1, Lennart Van der Veeken 2,*, Bettina Blaumeiser 3 and Katrien Janssens 3 1 Faculty of Medicine, University of Antwerp, 2610 Wilrijk, Belgium; [email protected] 2 Department of Obstetrics and Gynaecology, University Hospital Antwerp, 2650 Edegem, Belgium 3 Department of Medical Genetics, University Hospital and University of Antwerp, 2650 Edegem, Belgium; [email protected] (B.B.); [email protected] (K.J.) * Correspondence: [email protected] Abstract: We present a case of a fetus with cranial abnormalities typical of open spina bifida but with an intact spine shown on both ultrasound and fetal MRI. Expert ultrasound examination revealed a very small tract between the spine and the skin, and a postmortem examination confirmed the diagnosis of a dorsal dermal sinus. Genetic analysis found a mosaic 3q23q27 duplication in the form of a marker chromosome. This case emphasizes that meticulous prenatal ultrasound examination has the potential to diagnose even closed subtypes of neural tube defects. Furthermore, with cerebral anomalies suggesting a spina bifida, other imaging techniques together with genetic tests and measurement of alpha-fetoprotein in the amniotic fluid should be performed. Citation: Leroij, O.; Van der Veeken, Keywords: dorsal dermal sinus; Arnold–Chiari anomaly; 3q23q27 duplication; mosaic; marker chro- L.; Blaumeiser, B.; Janssens, K. mosome Pushing the Limits of Prenatal Ultrasound: A Case of Dorsal Dermal Sinus Associated with an Overt Arnold–Chiari Malformation and a 3q 1.
    [Show full text]
  • Chiari Malformation and Hydrocephalus Masking Neurocysticercosis Sharad Rajpal1, Colson Tomberlin2, Andrew Bauer1, Robert C
    Case Report Author's Personal Copy Chiari Malformation and Hydrocephalus Masking Neurocysticercosis Sharad Rajpal1, Colson Tomberlin2, Andrew Bauer1, Robert C. Forsythe3, Sigita Burneikiene1,4 Key words - BACKGROUND: Various diagnostic characteristics associated with neuro- - Chiari malformation cysticercosis have been well studied; however, their potential to be implicated - Hydrocephalus - Neurocysticercosis in other differential diagnoses has not been well demonstrated. - Subarachnoid cysts - CASE DESCRIPTION: We report the case of a 55-year-old Hispanic man who Abbreviations and Acronyms underwent a Chiari decompression surgery, which was complicated with hy- CP: Cerebellopontine drocephalus. Despite a ventriculoperitoneal shunt placement, he continued to MRI: Magnetic resonance imaging have headaches and was soon found to have several skull base subarachnoid VP: Ventriculoperitoneal lesions, which were later diagnosed as the sequelae of an active neuro- From the 1Boulder Neurosurgical Associates, 2University of cysticercosis infection. Colorado Boulder, 3Bouder Valley Pathology, and 4Justin Parker Neurological Institute, Boulder, Colorado, USA - CONCLUSION: This case report highlights the importance of overlapping To whom correspondence should be addressed: symptoms between diseases in a short temporal context. Sharad Rajpal, M.D. [E-mail: [email protected]] Citation: World Neurosurg. (2018) 114:68-71. https://doi.org/10.1016/j.wneu.2018.03.010 duraplasty. He had an uneventful hospital After approximately 8 months, the pa- Journal homepage: www.WORLDNEUROSURGERY.org course and was discharged home after 3 tient was seen in the emergency depart- days. The patient did well for several ment again for a fever, headache, balance Available online: www.sciencedirect.com months but then presented with recurrent problems, and myalgias. MRI of the brain 1878-8750/$ - see front matter ª 2018 Elsevier Inc.
    [Show full text]
  • Chiari Type II Malformation: Past, Present, and Future
    Neurosurg Focus 16 (2):Article 5, 2004, Click here to return to Table of Contents Chiari Type II malformation: past, present, and future KEVIN L. STEVENSON, M.D. Children’s Healthcare of Atlanta, Atlanta, Georgia Object. The Chiari Type II malformation (CM II) is a unique hindbrain herniation found only in patients with myelomeningocele and is the leading cause of death in these individuals younger than 2 years of age. Several theories exist as to its embryological evolution and recently new theories are emerging as to its treatment and possible preven- tion. A thorough understanding of the embryology, anatomy, symptomatology, and surgical treatment is necessary to care optimally for children with myelomeningocele and prevent significant morbidity and mortality. Methods. A review of the literature was used to summarize the clinically pertinent features of the CM II, with par- ticular attention to pitfalls in diagnosis and surgical treatment. Conclusions. Any child with CM II can present as a neurosurgical emergency. Expeditious and knowledgeable eval- uation and prompt surgical decompression of the hindbrain can prevent serious morbidity and mortality in the patient with myelomeningocele, especially those younger than 2 years old. Symptomatic CM II in the older child often pre- sents with more subtle findings but rarely in acute crisis. Understanding of CM II continues to change as innovative techniques are applied to this challenging patient population. KEY WORDS • Chiari Type II malformation • myelomeningocele • pediatric The CM II is uniquely associated with myelomeningo- four distinct forms of the malformation, including the cele and is found only in this population. Originally de- Type II malformation that he found exclusively in patients scribed by Hans Chiari in 1891, symptomatic CM II ac- with myelomeningocele.
    [Show full text]
  • 12 Neurological Anomalies
    BIOL 6505 − INTRODUCTION TO FETAL MEDICINE 12. NEUROLOGICAL ANOMALIES Petra Klinge, M.D. TOPICS • Myelodysplasia - Open vs. Closed neural tube defects • Hydrocephalus Congenital vs. Acquired I. MYELOMENINGOCELE (MMC)/OPEN NEURAL TUBE DEFECT • Single most common congenital defect of the central nervous system • 4.5/10,000 live births • 1500 cases/year despite dietary folate supplementation (50% reduction) • $200,000,000 health care dollars/year A. MMC - Embryogenesis • Initial closure of neural tube - day 21-23 • Cranial neuropore closure - day 23-25 • Caudal neuropore closure - day 25-27 • Spinal occlusion and initial ventricular expansion - day 25-32 • Secondary Neurulation - Caudal cell mass, Cavitation/retrogressive differentiation - day 27-54 B. Unified Mechanism D.G. McLone, M.D., Ph.D. • Open neural tube defect and leak of CSF into amniotic fluid - AFP positive • Loss of IV ventricular dilatation and expansion of rhombencephalon/posterior fossa • Small posterior fossa and creation of Chiari II malformation (Arnold Chiari malformation) C. MMC • Open neural tube defect - exposed neural placode • Chiari II malformation - Tectal beak, descent of IV ventricle, vermis herniation, medullary kink • Hydrocephalus, 85% require VPS D. MMC - Surgical Principals • Closure of open defect/MMC - 24-72 hours, minimizing risk of meningitis • CSF shunt/diversion for control of hydrocephalus, 80-90% cases 1 BIOL 6505 Spinal Dysraphism and Hydrocephalus: Neurosurgery in the Neonate (Continuation of Surgical Principals) • Chiari II decompression for stridor, airway obstruction, vocal cord paresis (less than 20%) E. Closure of MMC • Start IV antibiotics after birth • Cover neural placode with moist telfa and plastic wrap (saran). Keep moist • Avoid pressure to back. No peeking! • Family discussion with true objective • Planned, elective surgical procedure F.
    [Show full text]
  • Neurologic Outcomes in Friedreich Ataxia: Study of a Single-Site Cohort E415
    Volume 6, Number 3, June 2020 Neurology.org/NG A peer-reviewed clinical and translational neurology open access journal ARTICLE Neurologic outcomes in Friedreich ataxia: Study of a single-site cohort e415 ARTICLE Prevalence of RFC1-mediated spinocerebellar ataxia in a North American ataxia cohort e440 ARTICLE Mutations in the m-AAA proteases AFG3L2 and SPG7 are causing isolated dominant optic atrophy e428 ARTICLE Cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy revisited: Genotype-phenotype correlations of all published cases e434 Academy Officers Neurology® is a registered trademark of the American Academy of Neurology (registration valid in the United States). James C. Stevens, MD, FAAN, President Neurology® Genetics (eISSN 2376-7839) is an open access journal published Orly Avitzur, MD, MBA, FAAN, President Elect online for the American Academy of Neurology, 201 Chicago Avenue, Ann H. Tilton, MD, FAAN, Vice President Minneapolis, MN 55415, by Wolters Kluwer Health, Inc. at 14700 Citicorp Drive, Bldg. 3, Hagerstown, MD 21742. Business offices are located at Two Carlayne E. Jackson, MD, FAAN, Secretary Commerce Square, 2001 Market Street, Philadelphia, PA 19103. Production offices are located at 351 West Camden Street, Baltimore, MD 21201-2436. Janis M. Miyasaki, MD, MEd, FRCPC, FAAN, Treasurer © 2020 American Academy of Neurology. Ralph L. Sacco, MD, MS, FAAN, Past President Neurology® Genetics is an official journal of the American Academy of Neurology. Journal website: Neurology.org/ng, AAN website: AAN.com CEO, American Academy of Neurology Copyright and Permission Information: Please go to the journal website (www.neurology.org/ng) and click the Permissions tab for the relevant Mary E.
    [Show full text]
  • Spina Bifida and Chiari Malformation
    In partnership with Primary Children’s Hospital Spina bifida and Chiari malformation Normal Chiari malformation Cerebellum Foramen Cerebellar magnum tonsils Spinal cord Brainstem What is Chiari malformation? A Chiari malformation can cause: In Chiari (kee-ARE-ee) malformation, the brainstem • The brainstem, spinal cord, and cerebellum to stop and cerebellum are pushed down because there is working properly less space in the brain. Because the normal flow of • Cerebrospinal fluid (CSF) to stop flowing, which fluid is blocked, it builds up and increases pressure means less protection for the brain and spine on the brain. • Hydrocephalus (a buildup of CSF in the brain) There are four types of Chiari malformation. While type I is most common, type II is often associated How do I know if my child has with spina bifida. Chiari malformation? What happens when my child has If your child shows some or all of the following Chiari malformation? symptoms, have them checked for Chiari malformation: In a normal skull, the cerebellum (which controls balance) sits just above the spine. When the space for • Headaches the cerebellum is too small, part of the cerebellum • Difficulty breathing squeezes down the foramen magnum, a hole beneath • Not breathing (apnea) the skull. Part of the brainstem, which contains many nerves for the head, eyes, and neck, is pushed down • High-pitched noisy breathing (stridor) as well. • Problems swallowing or feeding (in babies) 1 • Arms that are weak and numb Chiari malformation symptoms are different at different ages. This table will give you the most common signs of Chairi malformation. Infants Poor feeding, not breathing (apnea), or arm weakness 10 years and younger High-pitched noisy breathing (stridor) Older than 10 Arm weakness, trouble breathing, and sometimes high pitched noisy breathing (stridor).
    [Show full text]
  • Cerebrospinal Fluid Leakage and Chiari I
    n e u r o l o g i a i n e u r o c h i r u r g i a p o l s k a 5 1 ( 2 0 1 7 ) 4 2 7 – 4 3 1 Available online at www.sciencedirect.com ScienceDirect journal homepage: http://www.elsevier.com/locate/pjnns Case report Cerebrospinal fluid leakage and Chiari I malformation with Gorham's disease of the skull base: A case report Hiroaki Nagashima *, Katsu Mizukawa, Masaaki Taniguchi, Yusuke Yamamoto, Eiji Kohmura Department of Neurosurgery, Kobe University Graduate School of Medicine, 7-5-2, Kusunoki-cho, Chuo-ku, Kobe 650-0017, Hyogo, Japan a r t i c l e i n f o a b s t r a c t Article history: Background: Gorham's syndrome is a rare bone disorder characterized by massive osteolysis Received 16 September 2016 of unknown etiology. There are no reports of comorbidity involving cerebrospinal fluid (CSF) Accepted 30 June 2017 leakage and Chiari I malformation with Gorham's syndrome. Here, we report an unusual Available online 13 July 2017 case of an acute presyrinx state complicated by bacterial meningitis due to CSF leakage and Chiari I malformation associated with Gorham's disease of the skull base. Keywords: Case presentation: A 25-year-old woman with Chiari I malformation associated with Gor- ham's syndrome presented with aggressive paresthesia following bacterial meningitis. Axial Gorham's syndrome Meningitis magnetic resonance imaging (MRI) and computed tomography (CT) cisternography revealed CSF leakage in the right petrous apex. A presyrinx state was diagnosed based on the clinical Cerebrospinal fluid leakage symptoms and MRI findings.
    [Show full text]
  • Argued April 23, 2002 Decided August 7, 2002 )
    UNITED STATES COURT OF APPEALS FOR VETERANS CLAIMS N O . 00-669 M ICHELLE C. JONES, APPELLANT, V. A NTHONY J. PRINCIPI, SECRETARY OF VETERANS AFFAIRS, APPELLEE. On Appeal from the Board of Veterans' Appeals (Argued April 23, 2002 Decided August 7, 2002 ) Michael P. Horan, of Washington, D.C., for the appellant. Kathy A. Banfield, with whom Tim S. McClain, General Counsel; R. Randall Campbell, Acting Assistant General Counsel; and Darryl A. Joe, Acting Deputy Assistant General Counsel, all of Washington, D.C., were on the pleadings, for the appellee. Before FARLEY, HOLDAWAY, and STEINBERG, Judges. STEINBERG, Judge: The appellant, the daughter of a Vietnam veteran, appeals through counsel a March 15, 2000, decision of the Board of Veterans' Appeals (Board or BVA) that denied entitlement to her, as a child of a Vietnam veteran, for a Department of Veterans Affairs (VA) monetary allowance for a disability resulting from spina bifida. Record (R.) at 6. The appellant filed a brief and a reply brief, and the Secretary filed a brief. Oral argument was held on April 23, 2002. On April 25, 2002, the Court ordered supplemental briefing from the parties. In response to the Court's order, the Secretary filed a supplemental record on appeal (ROA) and a supplemental memorandum of law, and the appellant filed a reply to the Secretary's supplemental memorandum. The Court has jurisdiction over the case under 38 U.S.C. §§ 7252(a) and 7266(a). For the reasons set forth below, the Court will vacate the Board decision on appeal and remand the matter for readjudication.
    [Show full text]
  • Management of Chiari Malformation in Pregnancy and Delivery
    Management of Chiari Malformation in Pregnancy and Delivery Mary Angela O’Neal, M.D. Janet Waters, MD, MBA Director of the Women’s Neurology Program Division Chief, Women’s Neurology Director of the Neurosciences clinic Associate Professor, University of Pittsburgh, Medical Center Pittsburgh, Pennsylvania Assistant Professor, Department of Neurology, Harvard Medical School Chiari Type I Downward displacement of the cerebellar tonsils below the foramen magnum of more than 5 mm May be associated with syringomyelia Images provided courtesy of Dr. Sanjay Prabhu; Staff Pediatric Neuroradiologist; Boston Children’s Hospital Chiari Type II Downward displacement of the cerebellar vermis and tonsils Kink in the medulla Hydrocephalus Syringomyelia Spinal myelomeningocele Chiari Type III Downward displacement of the cerebellum and brainstem Cervical or occipital encephalocele Spina bifida Chiari I Incidence Symptoms Labor concerns Ropper AH, Samuels, MA, Klein, JP. Developmental diseases of the nervous system. In Sydor AM, Davis KJ ed. Adams and Victor’s Principles of Neurology. 10th ed. New York, NY: McGraw Hill; 2014:1015-1017 Hullander, RM, Bogard TP, Leivers, D, Moran D, Dewan, DM. Chiari I malformation presenting as recurrent spinal headache. Anesth Analg. 1992;75:1025-6. Methods EMRs were used to identify all women who delivered at Magee Women’s Hospital & Brigham and Women’s Hospital between 1/2010 – 12/2015 with Chiari I malformation based on neuroimaging Excluded women who had undergone surgical decompression prior to delivery Retrospective chart review: demographics, neurologic history, radiology reports, choice of mode of delivery, anesthetic method and outcome were recorded Waters JFR, O’Neal MA, et al. Management of Anesthesia and Delivery in Women With Chiari I Malformations.
    [Show full text]
  • Spectrum of Clinical and Associated MR Imaging Findings in Children with Olfactory Anomalies
    Published March 17, 2016 as 10.3174/ajnr.A4738 ORIGINAL RESEARCH PEDIATRICS Spectrum of Clinical and Associated MR Imaging Findings in Children with Olfactory Anomalies X T.N. Booth and X N.K. Rollins ABSTRACT BACKGROUND AND PURPOSE: The olfactory apparatus, consisting of the bulb and tract, is readily identifiable on MR imaging. Anom- alous development of the olfactory apparatus may be the harbinger of anomalies of the secondary olfactory cortex and associated structures. We report a large single-site series of associated MR imaging findings in patients with olfactory anomalies. MATERIALS AND METHODS: A retrospective search of radiologic reports (2010 through 2014) was performed by using the keyword “olfactory”; MR imaging studies were reviewed for olfactory anomalies and intracranial and skull base malformations. Medical records were reviewed for clinical symptoms, neuroendocrine dysfunction, syndromic associations, and genetics. RESULTS: We identified 41 patients with olfactory anomalies (range, 0.03–18 years of age; M/F ratio, 19:22); olfactory anomalies were bilateral in 31 of 41 patients (76%) and absent olfactory bulbs and olfactory tracts were found in 56 of 82 (68%). Developmental delay was found in 24 (59%), and seizures, in 14 (34%). Pituitary dysfunction was present in 14 (34%), 8 had panhypopituitarism, and 2 had isolated hypogonadotropic hypogonadism. CNS anomalies, seen in 95% of patients, included hippocampal dysplasia in 26, cortical malformations in 15, malformed corpus callosum in 10, and optic pathway hypoplasia in 12. Infratentorial anomalies were seen in 15 (37%) patients and included an abnormal brain stem in 9 and an abnormal cerebellum in 3. Four patients had an abnormal membranous labyrinth.
    [Show full text]