Chiari Malformation Type I: Dysphagia and Glossopharyngeal Neuralgia. A Case Report
DOI:
https://doi.org/10.17533/udea.iatreia.263Keywords:
Arnold-Chiari Malformation, Colombia, Deglutition Disorders, Dysphagia, Glossopharyngeal Nerve DiseasesAbstract
Introduction: Chiari Malformation Type I (CM-I) involves the descent of the cerebellar tonsils 5 mm through the foramen magnum. This case report discusses a patient with dysphagia and glossopharyngeal neuralgia as unusual symptoms of CM-I.
Case Presentation: A 59-year-old Afro-Colombian housewife presented with a clinical picture that began three years ago with dysphagia for solids and liquids, coughing when swallowing, recurrent cervical pain, and xerostomia. A neurological examination revealed deviation of the uvula to the right and absence of the gag reflex. A cerebral nuclear magnetic resonance (NMR) was performed, showing the descent of the cerebellar tonsils through the foramen magnum, compressing the medulla oblongata. CM-I was diagnosed, and the anomaly was corrected. The patient reported complete improvement of dysphagia and associated symptoms.
Conclusions: CM-I poses a diagnostic challenge when presenting with dysphagia and glossopharyngeal neuralgia; however, timely diagnosis defines its proper management and prognosis.
Downloads
References
(1) Chiari H. Ueber Veränderungen des Kleinhirns infolge von Hydrocephalie des Grosshirns. Dtsch Med Wochenschr [Internet]. 1891;17(42):1172-5. https://doi.org/10.1055/s-0029-1206803
(2) Tubbs R, Turgut M, Oakes W. The Chiari Malformations [Internet]. 2nd ed. Cham Switzerland: Springer Cham; 2020. Available from: https://link.springer.com/book/10.1007/978-3-030-44862-2
(3) Schijman E. History, anatomic forms, and pathogenesis of Chiari I malformations. Childs Nerv Syst [Internet]. 2004;20(5):323-8. https://doi.org/10.1007/s00381-003-0878-y
(4) Tubbs RS, Lyerly MJ, Loukas M, Shoja MM, Oakes WJ. The pediatric Chiari I malformation: a review. Childs Nerv Syst [Internet]. 2007;23(11):1239-50. https://doi.org/10.1007/s00381-007-0428-0
(5) Passias PG, Pyne A, Horn SR, Poorman GW, Janjua MB, Vasquez-Montes D, et al. Developments in the treatment of Chiari type 1 malformations over the past decade. J Spine Surg (Hong Kong) [Internet]. 2018 Mar;4(1):45-54. https://doi.org/10.21037/jss.2018.03.14
(6) Turk ML, Schmidt K, McGrath ML. Diagnosis, Management, and Return to Sport of a 16-Year-Old Patient With a Chiari I Malformation: A Case Report and Literature Review. J Athl Train [Internet]. 2021 Jun 29;57(2):177-83. https://doi.org/10.4085/1062-6050-0001.21
(7) Sharma H, Treiber J, Bauer D. Chiari 1 and Hydrocephalus - A Review. Neurol India [Internet]. 2021;69(8):362-6. Available from: https://pubmed.ncbi.nlm.nih.gov/35102989/
(8) Whitson WJ, Lane JR, Bauer DF, Durham SR. A prospective natural history study of nonoperatively managed Chiari I malformation: does follow-up MRI surveillance alter surgical decision making? J Neurosurg Pediatr [Internet]. 2015;16(2):159-66. https://doi.org/10.3171/2014.12.PEDS14301
(9) McClugage SG, Oakes WJ. The Chiari I malformation. J Neurosurg Pediatr [Internet]. 2019 Sep;24(3):217-26. https://doi.org/10.3171/2019.5.PEDS18382
(10) Harrison D. Pathology of syringomyelia due to Chiari malformation. In: Ubbs R, Oakes W, editors. The Chiari malformations. New York: Springer; 2013. p. 121-5. https://doi.org/10.1007/978-1-4614-6369-6_9
(11) Gardner WJ, Angel J. The mechanism of syringomyelia and its surgical correction. Clin Neurosurg [Internet]. 1958;6:131-40. https://doi.org/10.1093/neurosurgery/6.CN_suppl_1.131
(12) Godzik J, Kelly MP, Radmanesh A, Kim D, Holekamp TF, Smyth MD, et al. Relationship of syrinx size and tonsillar descent to spinal deformity in Chiari malformation Type I with associated syringomyelia. J Neurosurg Pediatr [Internet]. 2014 Apr;13(4):368-74. https://doi.org/10.3171/2014.1.PEDS13105
(13) Oldfield EH, Muraszko K, Shawker TH, Patronas NJ. Pathophysiology of syringomyelia associated with Chiari I malformation of the cerebellar tonsils. Implications for diagnosis and treatment. J Neurosurg [Internet]. 1994 Jan;80(1):3-15. https://doi.org/10.3171/jns.1994.80.1.0003
(14) Meadows J, Kraut M, Guarnieri M, Haroun RI, Carson BS. Asymptomatic Chiari Type I malformations identified on magnetic resonance imaging. J Neurosurg [Internet]. 2000 Jun;92(6):920-6. https://doi.org/10.3171/jns.2000.92.6.0920
(15) Aitken LA, Lindan CE, Sidney S, Gupta N, Barkovich AJ, Sorel M, et al. Chiari type I malformation in a pediatric population. Pediatr Neurol [Internet]. 2009 Jun;40(6):449-54. https://doi.org/10.1016/j.pediatrneurol.2009.01.003
(16) Argente H, Álvarez M. Trastornos de la deglución. In: Semiología Médica. 2nd ed. 2013. p. 639-42.
(17) Almotairi FS, Andersson M, Andersson O, Skoglund T, Tisell M. Swallowing Dysfunction in Adult Patients with Chiari I Malformation. J Neurol Surg B Skull Base [Internet]. 2018 Dec;79(6):606-13. https://doi.org/10.1055/s-0038-1655758
(18) Aguiar PH, Tella OIJ, Pereira CU, Godinho F, Simm R. Chiari type I presenting as left glossopharyngeal neuralgia with cardiac syncope. Neurosurg Rev [Internet]. 2002 Mar;25(1-2):99-102. https://doi.org/10.1007/s101430100178
(19) Ruiz-Juretschke F, García-Leal R, Garcia-Duque S, Panadero T, Aracil C. Glossopharyngeal neuralgia in the context of a Chiari type I malformation. J Clin Neurosci [Internet]. 2012;19(4):614-6. https://doi.org/10.1016/j.jocn.2011.05.040
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2024 Iatreia
This work is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License.
Papers published in the journal are available for use under the Creative Commons license, specifically Attribution-NonCommercial-ShareAlike 4.0 International.
The papers must be unpublished and sent exclusively to the Journal Iatreia; the author uploading the contribution is required to submit two fully completed formats: article submission and authorship responsibility.
