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Scott J Luhmann - One of the best experts on this subject based on the ideXlab platform.

  • spinal cord monitoring data in pediatric spinal deformity patients with spinal cord pathology
    Spine deformity, 2015
    Co-Authors: Alexander W Aleem, Earl D Thuet, Anne M Padberg, Michael Wallendorf, Scott J Luhmann
    Abstract:

    Abstract Study Design Retrospective. Objectives The purpose of this study is to review the efficacy of monitoring data and outcomes in pediatric patients with spinal cord pathology. Summary of Background Data The incidence of spinal cord pathology in pediatric patients with scoliosis has been reported between 3% and 20%. Previous studies demonstrated that intraoperative spinal cord monitoring (IOM) during scoliosis surgery can be reliable despite underlying pathology. Methods A single-center retrospective review of 119 spinal surgery procedures in 82 patients with spinal cord pathology was performed. Diagnoses included Arnold-Chiari Malformation, syringomyelia, myelomeningocele, spinal cord tumor, tethered cord, and diastematomyelia. Baseline neurologic function and history of prior neurosurgical intervention were identified. Outcome measures included ability to obtain reliable monitoring data during surgery and presence of postoperative neurologic deficits. Results were compared for 82 patients with adolescent idiopathic scoliosis (AIS). Results Usable IOM data were obtained in 82% of cases (97/119). Twenty-two cases (18%) had no lower extremity data. Patients with Arnold-Chiari Malformation or syringomyelia pathologies, in isolation or together, had a significantly higher rate of reliable data compared to other pathologies (p Conclusions Spinal cord monitoring is a valuable tool in pediatric patients with spinal cord pathology undergoing spinal deformity surgeries. When obtained, data allow to detect changes in spinal cord function. Patients with a diagnosis of Arnold-Chiari or syringomyelia have monitoring data similar to those patients with AIS. Patients with other spinal cord pathologies have less reliable data, and surgeons should have a lower threshold for performing wake-up tests to assess spinal cord function intraoperatively.

P. M. A. Calverley - One of the best experts on this subject based on the ideXlab platform.

R De La Torre - One of the best experts on this subject based on the ideXlab platform.

  • acute respiratory failure as the first sign of Arnold Chiari Malformation associated with syringomyelia
    European Respiratory Journal, 1995
    Co-Authors: David Alvarez, I Requena, M Arias, L Valdes, I Pereiro, R De La Torre
    Abstract:

    We report a rare case of acute respiratory failure in a previously asymptomatic patient showing clinical signs of inferior cranial nerve palsy together with weakness and muscular atrophy of the upper limbs. Magnetic resonance imaging revealed Arnold-Chiari Malformation associated with platybasia, basilar impression, syringomyelia and Klippel-Feil syndrome. Episodes of apnoea required tracheostomy and recurred upon tentative closure of the tracheostome, but remitted upon decompression of the posterior fossa. This case involved both obstructive mechanisms and dysfunction of the respiratory centre. Patients with respiratory failure not explained by pulmonary pathology should be checked for underlying neurological disease.

Nebojsa Nick Knezevic - One of the best experts on this subject based on the ideXlab platform.

  • management of parturients in active labor with Arnold Chiari Malformation tonsillar herniation and syringomyelia
    Surgical Neurology International, 2017
    Co-Authors: Ramsis F Ghaly, Kenneth D Candido, Tatiana Tverdohleb, Nebojsa Nick Knezevic
    Abstract:

    Background Arnold-Chiari Malformation Type 1 (ACM-1) in parturients is a topic of ongoing discussion between obstetricians and anesthesiologists. The primary unanswered question remains; How should the anesthesia provider proceed with labor analgesia and anesthesia for cesarean section when confronted with an advanced, asymptomatic, or minimally symptomatic case of ACM-1 during labor? Case description A 24-year-old, ASA II, G1P0 full-term parturient presented to Labor and Delivery for vaginal delivery. A diagnosis of ACM-1 was made 12 years ago when a brain magnetic resonance imaging (MRI) was performed for right-sided numbness following a rear-end motor vehicle collision. The patient had been asymptomatic since then and had been seen by an outside neurologist frequently for the past 10 years. During the anesthesia evaluation, it was noted that she had an exaggerated patellar reflex, and a questionable left-sided Babinski; subsequently, an MRI study was requested. Review of a brain MRI demonstrated an advanced form of ACM with a 1.7 cm transtonsillar herniation and a large syrinx extending from C1 down to C5. Following a discussion with the patient, family, and primary OB team, a plan for elective cesarean section was made per neurosurgical recommendations. This was conducted uneventfully under general anesthesia. The patient had no complaints in the post-anesthesia care unit. Conclusion Unfamiliarity of health care providers with regards to ACM-1 parturients can be countered by increasing awareness of this condition throughout medical specialties involved in their care. The Ghaly Obstetric Guide to Arnold-Chiari Malformation Type 1, along with proper training of anesthesia care providers regarding the specificities of ACM-1 parturients aids in better management and understanding of this complex condition.

  • anesthetic management during cesarean section in a woman with residual Arnold Chiari Malformation type i cervical kyphosis and syringomyelia
    Surgical Neurology International, 2012
    Co-Authors: Ramsis F Ghaly, Kenneth D Candido, Ruben Sauer, Nebojsa Nick Knezevic
    Abstract:

    Background: Type I Arnold–Chiari Malformation (ACM) has an adult onset and consists of a downward displacement of the cerebellar tonsils and the medulla through the foramen magnum. There is paucity of literature on the anesthetic management during pregnancy of residual ACM Type I, with cervical xyphosis and persistent syringomyelia.

Giuseppe Di Maria - One of the best experts on this subject based on the ideXlab platform.

  • type i Arnold Chiari Malformation with bronchiectasis respiratory failure and sleep disordered breathing a case report
    Multidisciplinary Respiratory Medicine, 2013
    Co-Authors: Raffaele Campisi, Nicola Ciancio, Laura Bivona, Annalisa Di Maria, Giuseppe Di Maria
    Abstract:

    Arnold Chiari Malformation (ACM) is defined as a condition where part of the cerebellar tissue herniates into the cervical canal toward the medulla and spinal cord resulting in a number of clinical manifestations. Type I ACM consists of variable displacement of the medulla throughout the formamen magnum into the cervical canal, with prominent cerebellar herniation. Type I ACM is characterized by symptoms related to the compression of craniovertebral junction, including ataxia, dysphagia, nistagmus, headache, dizziness, and sleep disordered breathing. We report a case of a life-long non-smoker, 54 years old woman who presented these symptoms associated with bronchiectasis secondary to recurrent inhalation pneumonia, hypercapnic respiratory failure, and central sleep apnea (CSA). CSA was first unsuccessfully treated with nocturnal c-PAP. The subsequent treatment with low flow oxygen led to breathing pattern stabilization with resolution of CSA and related clinical symptoms during sleep. We suggest that in patients with type I ACM the presence of pulmonary manifestations aggravating other respiratory disturbances including sleep disordered breathing (SDB) should be actively investigated. The early diagnosis is desirable in order to avoid serious and/or poorly reversible damages.