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Federación Mexicana de Ginecología y Obstetricia, A.C.

2022, Number 08

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Ginecol Obstet Mex 2022; 90 (08)

Case Report: Arnold Chiari type 1 malformation in pregnant women

Romero-Luna DI, García-Benítez CQ, Jaime-Córdova A, Vargas-Aguilar DM

Language: Spanish
References: 25
Page: 682-687
PDF size: 195.93 Kb.


ABSTRACT

Background: Arnold-Chiari disease is a rare congenital malformation of the central nervous system, characterized by descent of the cerebellum below 5 mm from the level of the foramen magnum, with or without associated syringomyelia (types I or II). The average age at which type I disease is detected is 40 years. It is more frequent in women with a 3:1 ratio. Its manifestations are occipital headache (70-90%), neuropathic pain of cervical segments (40-70%); hyperreflexia of lower extremities (51%); atrophy of hands (35%) and paresis of upper (35%) and lower extremities (17%). Diagnosis is established based on magnetic resonance imaging.
Objetive: To analyze the anesthetic-obstetric behavior in a pregnant patient and the risk of complications derived from physiological and gestational changes.
Clinical case: 30-year-old patient, 38 weeks pregnant and diagnosed with Arnold- Chiari disease type I, with adequate neurological and obstetric control and satisfactory evolution. The pregnancy was terminated by delivery.
Conclusions: The medical care of the patient in the case was adequate because no complications were recorded, and it was possible to discharge her from the hospital in a very short time.


REFERENCES

  1. Vega-Lorenzo Y, Aparicio Álvarez E, Hidalgo Ávila M, CarmenateMendoza CD, Falcón Abreu A. Malformación de launión cráneo-cervical de Chiari. Presentación de un caso.MEDICIEGO; 2016; 22 (2). http://www.revmediciego.sld.cu/index.php/mediciego/article/view/476/961

  2. Schijman E. History, anatomic forms, and pathogenesis ofChiari I malformations. Childs Nerv Syst 2004; 20: 223-28.doi:10.1007/s00381-003-0878-y

  3. Gruffi TR, Peralta FM, Thakkar MS, McCarthy RJ, Habib AS.Anesthetic management of parturients with Arnold Chiarimalformation - I: a multicenter retrospective study. Int JObstet Anesth 2019; 37: 52-56; https://doi.org/10.1016/j.ijoa.2018.10.002

  4. Chantigian RC, Koehn MA, Ramin-Warner MA. Chiari imalformation in parturients. J Clin Anesth 2002; 14: 201-

  5. https://doi.org/10.1016/S0952-8180(02)00342-25. Parker JD, Broberg JC, Napolitano PG. Maternal Arnold-Chiari type i malformation and syringomyelia: a labormanagement dilemma. Am J Perinatology 2002; 8:445-50.doi:10.1055/s-2002-36841

  6. Mueller DM, Oro J. Chiari I Malformation with or withoutsryringomyelia and pregnancy: case studies and reviewof literature. Am J Perinatology 2005; 22: (2): 67-70.doi:10.1055/s-2005-837271

  7. López R, Nazar C, Sandoval P, Guerrero I, Mellado P, LacassieHJ. Malformación de Arnold-Chiari tipo I con siringomielia,trabajo de parto y analgesia neuroaxial. Revista Españolade Anestesiología y Reanimación 2007; 54: 317.

  8. Ghaly RF, Verdohleb T, Knezevic KD. Management of parturientsin active labor with Arnold Chiari malformation,tonsillar herniation, and syringomyelia. Surg Neurol Int2017; 8:10. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5288987/

  9. Cabezas Palacios MN, Tato Varela S, Barroso Castro JL,Santos Ridao F. Gestación gemelar en paciente con malformaciónde Arnold-Chiari tipo I asociada a siringomielia.Progresos de Obstetricia y Ginecología 2015; 58 (1): 29-32.http://dx.doi.org/10.1016/j.pog.2014.07.014

  10. Laund R, Giraud R, Delrue R, Kern C. Spinal anesthesia forcesarean delivery in a woman with a surgically correctedtype I Arnold Chiari. Anesth Analg 2003; 97;253-5.doi:10.1213/01.ANE.0000066312.32029.8B

  11. Ruiz Hernández I, Soler Cano A. Malformación de ArnoldChiari tipo I. Presentación de un caso. Revista Médica Electrónica2010; 32 (5). http://scielo.sld.cu/scielo.php?pid=S1684-18242010000500014&script=sci_arttext&tlng=en

  12. Vázquez ME, Barrón Fernández J, Chesa OE, De la CruzLabrado J, Escribano Silva M. Malformaciones de la unióncráneo-cervical (Chiari tipo 1 y siringomielia), documentode consenso. Madrid: Editorial Médica AWWE, 2009.https://www.sen.es/pdf/2010/Consenso_Chiari_2010.pdf

  13. Carrillo-Esper R, Vázquez-Elizondo G, Gutiérrez-DelgadoL, Guevara-Arnalb L, Méndez-Sánchez L. Malformaciónde Arnold-Chiari tipo I, siringomielia, siringobulbia yatrapamiento del ventrículo IV. Gac Méd Méx 2008; 144(4): https://www.medigraphic.com/cgi-bin/new/resumen.cgi?IDARTICULO=19336

  14. Newhouse BJ, Kuczkowski KM. Uneventful epidural laboranalgesia and vaginal delivery in a parturient withArnold-Chiari malformation type I and sickle cell disease.Arch Gynecology Obstet 2007; 275: 311-13. doi:10.1007/s00404-006-0215-2

  15. Choi CK, Tyagaraj K. Combined spinal-epidural analgesiafor laboring parturient Arnold-Chiari Type I malformation.A case report and a review of the literature. Case Reportsin Anesthesiology 2013, Article ID 512915, 5 pp. http://dx.doi.org/10.1155/2013/512915

  16. Agustí M, Adalia R, Fernández C, Gomar C. Anesthesiafor caesarean section in a patient with syringomyelia andArnold-Chiari type I malformation. Int J Obstetric Anesthesia2004; 13, 114-16. doi: 10.1016/j.ijoa.2003.09.005

  17. Cardona MA, Juncal JL. Paciente con Malformación deArnold Chiari en programa de cirugía ambulatoria. Cir MayAmb 2011; 16:144-47. http://www.asecma.org/Documentos/Articulos/8.CC2.pdf

  18. Sastry R, Surfianov R, Laviv Y, et al Chiari I Malformationand Pregnancy: a comprehensive review of the literature toaddress common questions and guide management. ActaNeurochir 2020; 162: 1565-73. http://doi.org/10.1007/s00701-020-04308-7

  19. Grainne P, Vibhangini S, Wasabe K, Murphy E. Anestheticand Obstetric Management of Syringomyelia DuringLabor and Delivery: A case series and Systematic Review.Anesth Analg 2017; 125: 913-24. doi: 10.1213/ANE.0000000000001987.

  20. Roper JC, Bassel H, Wattar AI, Adikarige HD, et al. Managementand birth outcomes of pregnant women with Chiarimalformations: A 14 years retrospective case series. Eur JObstetrics & Gynecology and Reproductive Biology 2018;230, 1-5. https://doi.org/10.1016/j.ejogrb.2018.09.006

  21. Hullander RM, Bogard TD, Leivers D, Moran D, DewanDM. Chiari I Malformation Presenting as Recurrent SpinalHeadache. Anesth Analg 1992; 75;1025-26.

  22. Agustí RM Adalia C, Fernandez C. Anaesthesia forCaesarean section in a patient with syringomyelia andArnold -Chiari Type I malformation. Int J Obstet Anesth2004;13:114-16. Doi :10.1016/j.ijoa.2003.09.005

  23. Miqi Mavis T. Spinal neuroaxial anesthesia for caesareansection in a parturient with type I Arnold Chiari malformationand syringomyelia. SAGE Open Medical Case Reports2018; 6: 1-3. doi:10.1177/2050313X18786114

  24. Knafo S, Picard B, Morar S, Aghakhani N, Samadi M, ParkerF, Benhamou D. Management of Chiari malformationtype I and syringomyelia during pregnancy and delivery.J Gynecol Obstet Hum Reprod 2021; 50; 101970. http://dx.doi.org/10.1016/j.jogoh.2020.101970

  25. Water JF, O´Neal MA, Pilato M, Waters S, Larkin JC, WatersJH. Management of anesthesia and delivery in women withChiari I malformations. Obstetrics & Gynecology 2018,132 (5): 1180-85. doi: 10.1097/AOG.0000000000002943.




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