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Federación Mexicana de Ginecología y Obstetricia, A.C.

2023, Number 02

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Ginecol Obstet Mex 2023; 91 (02)

Chiari malformation type I in pregnant women, case report

Hoyos-Guerrero DM, Aragón-Mendoza RL, Hernández-Restrepo M, Alba-Romero EA

Language: Spanish
References: 21
Page: 133-139
PDF size: 404.80 Kb.


ABSTRACT

Background: Chiari malformation is a rare congenital or acquired neurological disorder, characterized by the displacement of the rhombencephalic structures towards the spinal canal below the level of the foramen magnum; The frequency and progression that can occur during pregnancy are unknown, since there are changes during labor that can predispose to brainstem herniation with spinal cord compression; which poses a therapeutic challenge since there are no unified recommendations about the moment of delivery, delivery route and the best anesthetic technique in these patients
Clinical case: A 24-year-old patient, G1P0 with a 34-week pregnancy, consulted the emergency room of the Hospital Universitario de la Samaritana, due to a clinical profile of headache with warning signs; to the study of cerebral magnetic resonance with a finding of Chiari type I malformation. In order to limit the Valsalva maneuvers during labor, a caesarean section was performed at term under neuraxial anesthesia without complications with a healthy newborn.
Conclusion: Chiari malformation type I during pregnancy is rare. Patients diagnosed prior to pregnancy condition a follow-up in which the indication for neurosurgical treatment prior to conception is assessed. During pregnancy, no single method of termination or anaesthesia can be recommended and medical care should be provided by a multidisciplinary team formulating an individualized care plan to improve maternal and fetal outcome.


REFERENCES

  1. Callen P, Norton M. Callen. Ecografía en obstetricia y ginecología.5a ed. Madrid: Elsevier, 2019.

  2. Nie Y, Zhou W, Huang S. Anesthetic management for cesareandelivery in a woman with congenital atlantoaxialdislocation and Chiari type I anomaly: a case report andliterature review. BMC Pregnancy and Childbirth. 2021;21(1). https://doi:10.1186/s12884-021-03751-3

  3. Meadows J, Kraut M, Guarnieri M, Haroun R, et al. AsymptomaticChiari Type I malformations identified on magneticresonance imaging. J Neurosurgery 2000; 92(6), 920–926.https://doi:10.3171/jns.2000.92.6.0920

  4. Janjua M, Haynie A, Bansal V, Bhattacharia S, et al. Determinantsof Chiari I progression in pregnancy. J Clin Neuroscien2020; 77: 1-7. https://doi:10.1016/j.jocn.2020.05.026

  5. Choi CK, Tyagaraj K. Combined Spinal-Epidural Analgesiafor Laboring Parturient with Arnold-Chiari Type I Malformation:A Case Report and a Review of the Literature.Case Reports in Anesthesiology 2013; 1-5. https://doi:10.1155/2013/512915

  6. Rogers JM, Savage G, Stoodley MA. A Systematic Reviewof Cognition in Chiari I Malformation. NeuropsychologyReview 2018; 28 (2): 176-87. https://doi:10.1007/s11065-018-9368-6

  7. Capra V, Iacomino M, Accogli A, Pavanello M, et al. Chiarimalformation type I: what information from the genetics?Childs Nerv Syst 2019. https://doi:10.1007/s00381-019-04322-w

  8. Caldarelli M, Di Rocco C. Diagnosis of Chiari I malformationand related syringomyelia: radiological and neurophysiologicalstudies. Childs Nerv Syst 2004; 20: 332.

  9. Piper RJ, Pike M, Harrington R, Magdum SA. Chiari malformations:principles of diagnosis and management. BMJ2019; 365: l1159.

  10. Guillen A, Costa JM. Spontaneous resolution of a Chiari Imalformation associated syringomyelia in one child. ActaNeurochir (Wien) 2004; 146: 187.

  11. Massimi L, Peretta P, Erbetta A, et al. Diagnosis andtreatment of Chiari malformation type 1 in children: the InternationalConsensus Document. Neurol Sci 2022; 43: 1311.

  12. Leon TJ, Kuhn EN, Arynchyna AA, et al. Patients with“benign” Chiari I malformations require surgical decompressionat a low rate. J Neurosurg Pediatr 2019; 23: 498.

  13. Singhal A, Cheong A, Steinbok P. International surveyon the management of Chiari 1 malformation and syringomyelia:evolving worldwide opinions. Childs Nerv Syst2018; 34: 1177.

  14. Pakzaban P. Chiari malformation. 2010; http://emedicine.medscape.com/article/1483583-overview

  15. Luengo Á, Zornoza V, Caro JJ. Malformación de Arnold-Chiari tipo I en embarazada. Clínica e Investigación enGinecología y Obstetricia 2009; 36 (1): 25-27. https://doi:10.1016/j.gine.2007.07.001

  16. Jeffree RL, Stoodley MA. Management of Chiari in pregnancy.J Clin Neuroscience 2021; 83: 153-54. https://doi:10.1016/j.jocn.2020.10.025

  17. Cabezas M, Tato S, Barroso JL, Santos F. Gestación gemelaren paciente con malformación de Arnold-Chiaritipo I asociada a siringomielia. Progresos de Obstetriciay Ginecología 2015; 58 (1): 29-32. https://doi:10.1016/j.pog.2014.07.014

  18. Teo, Miqi Mavis. Spinal neuraxial anaesthesia for caesareansection in a parturient with type I Arnold Chiarimalformation and syringomyelia. SAGE Open MedicalCase Reports 2018; 6: 2050313X1878611. https://doi:10.1177/2050313X18786114

  19. Waters FR, OʼNeal MA, Pilato M, Waters S, et al. Managementof anesthesia and delivery in women with ChiariI Malformations. Obstetrics & Gynecology 2018; 132 (5):1180-184. https://doi:10.1097/AOG.0000000000002943

  20. Agustı́ M, Adàlia R, Fernández C, Gomar C. Anaesthesiafor caesarean section in a patient with syringomyeliaand Arnold-Chiari type I malformation. Int J ObstetricAnesthesia 2004; 13 (2): 114-16. https://doi:10.1016/j.ijoa.2003.09.005

  21. Jayaraman L, Sethi N, Sood J. Anestesia para cesarea enpaciente con siringomielia lumbar. Rev Bras Anestesiol2011; 61: 255-7.




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