Arnold‐Chiari malformation type 1 as an unusual cause of acute respiratory failure: A case report

<p dir="ltr">The authors urge clinicians to consider the possibility of Arnold-Chiari Malformation type 1 with other central causes especially in cases where acute respiratory failure is unexplainable.</p><h3>BACKGROUND</h3><p dir="ltr">Chiari malfor...

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Main Author: Mohamad Y. Khatib (11659459) (author)
Other Authors: Moustafa S. Elshafei (11659426) (author), Amr M. Shabana (14777140) (author), Dnyaneshwar P. Mutkule (14777143) (author), Dinesh Chengamaraju (14777146) (author), Nevin Kannappilly (14777149) (author), Nazeer Alaudeen (14777152) (author), Ruchir Milind Joshi (14777155) (author), Abdulqadir J. Naswhan (14777158) (author)
Published: 2020
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_version_ 1864513566121394176
author Mohamad Y. Khatib (11659459)
author2 Moustafa S. Elshafei (11659426)
Amr M. Shabana (14777140)
Dnyaneshwar P. Mutkule (14777143)
Dinesh Chengamaraju (14777146)
Nevin Kannappilly (14777149)
Nazeer Alaudeen (14777152)
Ruchir Milind Joshi (14777155)
Abdulqadir J. Naswhan (14777158)
author2_role author
author
author
author
author
author
author
author
author_facet Mohamad Y. Khatib (11659459)
Moustafa S. Elshafei (11659426)
Amr M. Shabana (14777140)
Dnyaneshwar P. Mutkule (14777143)
Dinesh Chengamaraju (14777146)
Nevin Kannappilly (14777149)
Nazeer Alaudeen (14777152)
Ruchir Milind Joshi (14777155)
Abdulqadir J. Naswhan (14777158)
author_role author
dc.creator.none.fl_str_mv Mohamad Y. Khatib (11659459)
Moustafa S. Elshafei (11659426)
Amr M. Shabana (14777140)
Dnyaneshwar P. Mutkule (14777143)
Dinesh Chengamaraju (14777146)
Nevin Kannappilly (14777149)
Nazeer Alaudeen (14777152)
Ruchir Milind Joshi (14777155)
Abdulqadir J. Naswhan (14777158)
dc.date.none.fl_str_mv 2020-06-17T00:00:00Z
dc.identifier.none.fl_str_mv 10.1002/ccr3.3043
dc.relation.none.fl_str_mv https://figshare.com/articles/journal_contribution/Arnold_Chiari_malformation_type_1_as_an_unusual_cause_of_acute_respiratory_failure_A_case_report/22257544
dc.rights.none.fl_str_mv CC BY 4.0
info:eu-repo/semantics/openAccess
dc.subject.none.fl_str_mv Biological sciences
Genetics
Biomedical and clinical sciences
Cardiovascular medicine and haematology
Neurosciences
Chiari Malformations
Neurology
Cerebrospinal Fluid (CSF)
Ataxia
dc.title.none.fl_str_mv Arnold‐Chiari malformation type 1 as an unusual cause of acute respiratory failure: A case report
dc.type.none.fl_str_mv Text
Journal contribution
info:eu-repo/semantics/publishedVersion
text
contribution to journal
description <p dir="ltr">The authors urge clinicians to consider the possibility of Arnold-Chiari Malformation type 1 with other central causes especially in cases where acute respiratory failure is unexplainable.</p><h3>BACKGROUND</h3><p dir="ltr">Chiari malformations are a group of heterogeneous disorders; Chiari I malformation is characterized by a form of structural defect in the cerebellum and the cranial base. The case report highlights the possibility of underlying neurological disease in cases where acute type 2 respiratory failure is unexplainable.</p><p dir="ltr">Historically, Hans von Chiari described certain hindbrain abnormalities as postmortem findings in infants; these came to be known as Chiari malformations. Four types of Chiari malformations are described in the literature: types I, II, III, and IV.<a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0001" target="_blank">1</a>, <a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0002" target="_blank">2</a> (Chiari malformation types II, III, and IV are distinct from type I and are not discussed in this article). Chiari I malformation is the most common, having been estimated to occur in 1 in 1000 births.<a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0001" target="_blank">1</a></p><p dir="ltr">Arnold-Chiari type I malformation (type I ACM or CM-I) is characterized by cerebellar tonsils herniation and downwardly displaced below the level of the foramen magnum. Typically, tonsils lying 5 mm or more (normally 3 mm) below the foramen magnum on neuroimaging are consistent with an ACM. However, there is no known direct correlation between clinical severity and the tonsils position.</p><p dir="ltr">The actual nature of CM-I has not been fully understood.<a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0002" target="_blank">2</a> In most cases, CM-I does not become symptomatic until adolescence or adulthood<a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0003" target="_blank">3</a>-<a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0005" target="_blank">5</a> and the mean age at presentation is approximately 18 years.<a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0006" target="_blank">6</a> Also, symptom onset is often insidious. Usually, symptoms of type I ACM develop as a result of the following mechanisms: cerebellum, medulla, and upper spinal cord compression, and disruption of cerebral spinal fluid (CSF) flow through the foramen magnum. Medulla and spinal cord compression may result in spinal cord injury and lower cranial nerve and nuclear dysfunction. Also, the cerebellum compression may result in various neurological symptoms such as dysequilibrium, dysmetria, ataxia, and nystagmus. Disruption of the CSF flow through foramen magnum probably leads to the most common symptom, which is pain.</p><h2>Other Information</h2><p dir="ltr">Published in: Clinical Case Reports<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="http://dx.doi.org/10.1002/ccr3.3043" target="_blank">http://dx.doi.org/10.1002/ccr3.3043</a></p>
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identifier_str_mv 10.1002/ccr3.3043
network_acronym_str Manara2
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oai_identifier_str oai:figshare.com:article/22257544
publishDate 2020
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rights_invalid_str_mv CC BY 4.0
spelling Arnold‐Chiari malformation type 1 as an unusual cause of acute respiratory failure: A case reportMohamad Y. Khatib (11659459)Moustafa S. Elshafei (11659426)Amr M. Shabana (14777140)Dnyaneshwar P. Mutkule (14777143)Dinesh Chengamaraju (14777146)Nevin Kannappilly (14777149)Nazeer Alaudeen (14777152)Ruchir Milind Joshi (14777155)Abdulqadir J. Naswhan (14777158)Biological sciencesGeneticsBiomedical and clinical sciencesCardiovascular medicine and haematologyNeurosciencesChiari MalformationsNeurologyCerebrospinal Fluid (CSF)Ataxia<p dir="ltr">The authors urge clinicians to consider the possibility of Arnold-Chiari Malformation type 1 with other central causes especially in cases where acute respiratory failure is unexplainable.</p><h3>BACKGROUND</h3><p dir="ltr">Chiari malformations are a group of heterogeneous disorders; Chiari I malformation is characterized by a form of structural defect in the cerebellum and the cranial base. The case report highlights the possibility of underlying neurological disease in cases where acute type 2 respiratory failure is unexplainable.</p><p dir="ltr">Historically, Hans von Chiari described certain hindbrain abnormalities as postmortem findings in infants; these came to be known as Chiari malformations. Four types of Chiari malformations are described in the literature: types I, II, III, and IV.<a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0001" target="_blank">1</a>, <a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0002" target="_blank">2</a> (Chiari malformation types II, III, and IV are distinct from type I and are not discussed in this article). Chiari I malformation is the most common, having been estimated to occur in 1 in 1000 births.<a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0001" target="_blank">1</a></p><p dir="ltr">Arnold-Chiari type I malformation (type I ACM or CM-I) is characterized by cerebellar tonsils herniation and downwardly displaced below the level of the foramen magnum. Typically, tonsils lying 5 mm or more (normally 3 mm) below the foramen magnum on neuroimaging are consistent with an ACM. However, there is no known direct correlation between clinical severity and the tonsils position.</p><p dir="ltr">The actual nature of CM-I has not been fully understood.<a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0002" target="_blank">2</a> In most cases, CM-I does not become symptomatic until adolescence or adulthood<a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0003" target="_blank">3</a>-<a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0005" target="_blank">5</a> and the mean age at presentation is approximately 18 years.<a href="https://onlinelibrary.wiley.com/doi/10.1002/ccr3.3043#ccr33043-bib-0006" target="_blank">6</a> Also, symptom onset is often insidious. Usually, symptoms of type I ACM develop as a result of the following mechanisms: cerebellum, medulla, and upper spinal cord compression, and disruption of cerebral spinal fluid (CSF) flow through the foramen magnum. Medulla and spinal cord compression may result in spinal cord injury and lower cranial nerve and nuclear dysfunction. Also, the cerebellum compression may result in various neurological symptoms such as dysequilibrium, dysmetria, ataxia, and nystagmus. Disruption of the CSF flow through foramen magnum probably leads to the most common symptom, which is pain.</p><h2>Other Information</h2><p dir="ltr">Published in: Clinical Case Reports<br>License: <a href="http://creativecommons.org/licenses/by/4.0/" target="_blank">http://creativecommons.org/licenses/by/4.0/</a><br>See article on publisher's website: <a href="http://dx.doi.org/10.1002/ccr3.3043" target="_blank">http://dx.doi.org/10.1002/ccr3.3043</a></p>2020-06-17T00:00:00ZTextJournal contributioninfo:eu-repo/semantics/publishedVersiontextcontribution to journal10.1002/ccr3.3043https://figshare.com/articles/journal_contribution/Arnold_Chiari_malformation_type_1_as_an_unusual_cause_of_acute_respiratory_failure_A_case_report/22257544CC BY 4.0info:eu-repo/semantics/openAccessoai:figshare.com:article/222575442020-06-17T00:00:00Z
spellingShingle Arnold‐Chiari malformation type 1 as an unusual cause of acute respiratory failure: A case report
Mohamad Y. Khatib (11659459)
Biological sciences
Genetics
Biomedical and clinical sciences
Cardiovascular medicine and haematology
Neurosciences
Chiari Malformations
Neurology
Cerebrospinal Fluid (CSF)
Ataxia
status_str publishedVersion
title Arnold‐Chiari malformation type 1 as an unusual cause of acute respiratory failure: A case report
title_full Arnold‐Chiari malformation type 1 as an unusual cause of acute respiratory failure: A case report
title_fullStr Arnold‐Chiari malformation type 1 as an unusual cause of acute respiratory failure: A case report
title_full_unstemmed Arnold‐Chiari malformation type 1 as an unusual cause of acute respiratory failure: A case report
title_short Arnold‐Chiari malformation type 1 as an unusual cause of acute respiratory failure: A case report
title_sort Arnold‐Chiari malformation type 1 as an unusual cause of acute respiratory failure: A case report
topic Biological sciences
Genetics
Biomedical and clinical sciences
Cardiovascular medicine and haematology
Neurosciences
Chiari Malformations
Neurology
Cerebrospinal Fluid (CSF)
Ataxia