Acute respiratory failure and sleep-disordered breathing in Arnold–Chiari malformation
We report on the case of a 32-year-old man who was admitted after an episode of acute respiratory failure. Clinical and laboratory investigations revealed nocturnal hypoventilation with predominately obstructive sleep apneas accompanied by lower cranial nerve palsies, cerebellar and mild pyramidal s...
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| Veröffentlicht in: | Clinical neurology and neurosurgery 2005-10, Vol.107 (6), p.521-524 |
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| creator | Tsara, Venetia Serasli, Eva Kimiskidis, Vassilios Papagianopoulos, Sotirios Katsaridis, Vassilios Fylaktakis, Makedos Christaki, Pandora Kazis, Aristidis |
| description | We report on the case of a 32-year-old man who was admitted after an episode of acute respiratory failure. Clinical and laboratory investigations revealed nocturnal hypoventilation with predominately obstructive sleep apneas accompanied by lower cranial nerve palsies, cerebellar and mild pyramidal signs. Magnetic resonance imaging disclosed Arnold–Chiari type I malformation with syringomyelia. Transcranial magnetic stimulation demonstrated the integrity of the corticodiaphragmatic pathway and it was postulated that the respiratory disorder was mainly due to the severe and irreversible lower cranial nerve palsies. Two years after decompressive craniectomy, sleep disordered-breathing persisted despite no radiological evidence of brain stem compression. Nevertheless, non-invasive positive pressure ventilation (NIPPV) during sleep proved to be quite effective in the management of the patient's refractory respiratory insufficiency. In conclusion, Arnold–Chiari type I may rarely present with acute respiratory failure and sleep apneas. An electrophysiological investigation into the mechanism of the respiratory dysfunction is presented. |
| doi_str_mv | 10.1016/j.clineuro.2004.10.008 |
| format | Article |
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Clinical and laboratory investigations revealed nocturnal hypoventilation with predominately obstructive sleep apneas accompanied by lower cranial nerve palsies, cerebellar and mild pyramidal signs. Magnetic resonance imaging disclosed Arnold–Chiari type I malformation with syringomyelia. Transcranial magnetic stimulation demonstrated the integrity of the corticodiaphragmatic pathway and it was postulated that the respiratory disorder was mainly due to the severe and irreversible lower cranial nerve palsies. Two years after decompressive craniectomy, sleep disordered-breathing persisted despite no radiological evidence of brain stem compression. Nevertheless, non-invasive positive pressure ventilation (NIPPV) during sleep proved to be quite effective in the management of the patient's refractory respiratory insufficiency. In conclusion, Arnold–Chiari type I may rarely present with acute respiratory failure and sleep apneas. An electrophysiological investigation into the mechanism of the respiratory dysfunction is presented.</description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2004.10.008</identifier><identifier>PMID: 16202827</identifier><identifier>CODEN: CNNSBV</identifier><language>eng</language><publisher>Amsterdam: Elsevier B.V</publisher><subject>Acute Disease ; Acute respiratory failure ; Adult ; Arnold-Chiari Malformation - diagnosis ; Arnold-Chiari Malformation - physiopathology ; Arnold–Chiari malformation ; Biological and medical sciences ; Cervical Vertebrae - pathology ; Diagnosis, Differential ; Diaphragm - innervation ; Evoked Potentials, Motor - physiology ; Follow-Up Studies ; Humans ; Hypercapnia - diagnosis ; Hypercapnia - etiology ; Hypercapnia - physiopathology ; Magnetic Resonance Imaging ; Male ; Medical sciences ; Neurologic Examination ; Neurology ; Neurosurgery ; Non-invasive positive pressure ventilation ; Polysomnography ; Respiratory Insufficiency - diagnosis ; Respiratory Insufficiency - etiology ; Respiratory Insufficiency - physiopathology ; Sleep apnea ; Sleep Apnea, Obstructive - diagnosis ; Sleep Apnea, Obstructive - physiopathology ; Surgery (general aspects). Transplantations, organ and tissue grafts. 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Clinical and laboratory investigations revealed nocturnal hypoventilation with predominately obstructive sleep apneas accompanied by lower cranial nerve palsies, cerebellar and mild pyramidal signs. Magnetic resonance imaging disclosed Arnold–Chiari type I malformation with syringomyelia. Transcranial magnetic stimulation demonstrated the integrity of the corticodiaphragmatic pathway and it was postulated that the respiratory disorder was mainly due to the severe and irreversible lower cranial nerve palsies. Two years after decompressive craniectomy, sleep disordered-breathing persisted despite no radiological evidence of brain stem compression. Nevertheless, non-invasive positive pressure ventilation (NIPPV) during sleep proved to be quite effective in the management of the patient's refractory respiratory insufficiency. In conclusion, Arnold–Chiari type I may rarely present with acute respiratory failure and sleep apneas. An electrophysiological investigation into the mechanism of the respiratory dysfunction is presented.</description><subject>Acute Disease</subject><subject>Acute respiratory failure</subject><subject>Adult</subject><subject>Arnold-Chiari Malformation - diagnosis</subject><subject>Arnold-Chiari Malformation - physiopathology</subject><subject>Arnold–Chiari malformation</subject><subject>Biological and medical sciences</subject><subject>Cervical Vertebrae - pathology</subject><subject>Diagnosis, Differential</subject><subject>Diaphragm - innervation</subject><subject>Evoked Potentials, Motor - physiology</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Hypercapnia - diagnosis</subject><subject>Hypercapnia - etiology</subject><subject>Hypercapnia - physiopathology</subject><subject>Magnetic Resonance Imaging</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Neurologic Examination</subject><subject>Neurology</subject><subject>Neurosurgery</subject><subject>Non-invasive positive pressure ventilation</subject><subject>Polysomnography</subject><subject>Respiratory Insufficiency - diagnosis</subject><subject>Respiratory Insufficiency - etiology</subject><subject>Respiratory Insufficiency - physiopathology</subject><subject>Sleep apnea</subject><subject>Sleep Apnea, Obstructive - diagnosis</subject><subject>Sleep Apnea, Obstructive - physiopathology</subject><subject>Surgery (general aspects). 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Clinical and laboratory investigations revealed nocturnal hypoventilation with predominately obstructive sleep apneas accompanied by lower cranial nerve palsies, cerebellar and mild pyramidal signs. Magnetic resonance imaging disclosed Arnold–Chiari type I malformation with syringomyelia. Transcranial magnetic stimulation demonstrated the integrity of the corticodiaphragmatic pathway and it was postulated that the respiratory disorder was mainly due to the severe and irreversible lower cranial nerve palsies. Two years after decompressive craniectomy, sleep disordered-breathing persisted despite no radiological evidence of brain stem compression. Nevertheless, non-invasive positive pressure ventilation (NIPPV) during sleep proved to be quite effective in the management of the patient's refractory respiratory insufficiency. In conclusion, Arnold–Chiari type I may rarely present with acute respiratory failure and sleep apneas. An electrophysiological investigation into the mechanism of the respiratory dysfunction is presented.</abstract><cop>Amsterdam</cop><pub>Elsevier B.V</pub><pmid>16202827</pmid><doi>10.1016/j.clineuro.2004.10.008</doi><tpages>4</tpages></addata></record> |
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| subjects | Acute Disease Acute respiratory failure Adult Arnold-Chiari Malformation - diagnosis Arnold-Chiari Malformation - physiopathology Arnold–Chiari malformation Biological and medical sciences Cervical Vertebrae - pathology Diagnosis, Differential Diaphragm - innervation Evoked Potentials, Motor - physiology Follow-Up Studies Humans Hypercapnia - diagnosis Hypercapnia - etiology Hypercapnia - physiopathology Magnetic Resonance Imaging Male Medical sciences Neurologic Examination Neurology Neurosurgery Non-invasive positive pressure ventilation Polysomnography Respiratory Insufficiency - diagnosis Respiratory Insufficiency - etiology Respiratory Insufficiency - physiopathology Sleep apnea Sleep Apnea, Obstructive - diagnosis Sleep Apnea, Obstructive - physiopathology Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Transcranial Magnetic Stimulation |
| title | Acute respiratory failure and sleep-disordered breathing in Arnold–Chiari malformation |
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