Advertisement

MRI Findings and Sleep Apnea in Children With Chiari I Malformation

      Abstract

      Chiari I malformation is characterized by downward herniation of the cerebellar tonsils through the foramen magnum. Scant data are available on the clinical course, relationship to the extent of herniation on magnetic resonance imaging in Chiari I malformation and the presence of sleep-disordered breathing on polysomnography. Retrospective analysis was performed looking at polysomnographic findings of children diagnosed with Chiari I malformation. Details on how Chiari I malformation was diagnosed, brainstem magnetic resonance imaging findings, and indications for obtaining the polysomnogram in these patients were reviewed. We also reviewed available data on children who had decompression surgery followed by postoperative polysomnography findings. Twenty-two children were identified in our study (11 males, median age 10 years, range 1 to 18). Three had central sleep apnea, five had obstructive sleep apnea, and one had both obstructive and central sleep apnea. Children with sleep-disordered breathing had excessive crowding of the brainstem structures at the foramen magnum and were more likely to have a greater length of herniation compared with those children without sleep-disordered breathing (P = 0.046). Patients with central sleep apneas received surgical decompression, and their conditions were significantly improved on follow-up polysomnography. These data suggest that imaging parameters may correlate with the presence of sleep-disordered breathing in children with Chiari I malformation.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Pediatric Neurology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Chiari H.
        Concerning alterations in the cerebellum resulting from cerebral hydrocephalus. 1891.
        Pediatr Neurosci. 1987; 13: 3-8
        • Speer M.C.
        • Enterline D.S.
        • Mehltretter L.
        • et al.
        Review Article: Chiari type I malformation with or without syringomyelia: Prevalence and genetics.
        J Genetic Counseling. 2003; 12: 297-311
        • Yassari R.
        • Frim D.
        Evaluation and management of the Chiari malformation type 1 for the primary care pediatrician.
        Pediatr Clin North Am. 2004; 51: 477-490
        • Riva D.
        • Usilla A.
        • Saletti V.
        • Esposito S.
        • Bulgheroni S.
        Can Chiari malformation negatively affect higher mental functioning in developmental age?.
        Neurol Sci. 2011; 32: S307-S309
        • Prilipko O.
        • Dehdashti A.R.
        • Zaim S.
        • Seeck M.
        Orthostatic intolerance and syncope associated with Chiari type I malformation.
        J Neurol Neurosurg Psychiatry. 2005; 76: 1034-1036
        • Botelho R.V.
        • Bittencourt L.R.
        • Rotta J.M.
        • Tufik S.
        The effects of posterior fossa decompressive surgery in adult patients with Chiari malformation and sleep apnea.
        J Neurosurg. 2010; 112: 800-807
        • Dauvilliers Y.
        • Stal V.
        • Abril B.
        • et al.
        Chiari malformation and sleep related breathing disorders.
        J Neurol Neurosurg Psychiatry. 2007; 78: 1344-1348
        • Henriques-Filho P.S.
        • Pratesi R.
        Sleep apnea and REM sleep behavior disorder in patients with Chiari malformations.
        Arq Neuropsiquiatr. 2008; 66: 344-349
        • American Academy of Sleep Medicine
        The International Classification of Sleep Disorders Diagnostic and Coding Manual. American Academy of Sleep Medicine, Westchester, IL2005
        • Li H.Y.
        • Lee L.A.
        Sleep-disordered breathing in children.
        Chang Gung Med J. 2009; 32: 247-257
        • Botelho R.V.
        • Bittencourt L.R.
        • Rotta J.M.
        • Tufik S.
        A prospective controlled study of sleep respiratory events in patients with craniovertebral junction malformation.
        J Neurosurg. 2003; 99: 1004-1009
        • Gosalakkal J.A.
        Sleep-disordered breathing in Chiari malformation type 1.
        Pediatr Neurol. 2008; 39: 207-208
        • Ely E.W.
        • McCall W.V.
        • Haponik E.F.
        Multifactorial obstructive sleep apnea in a patient with Chiari malformation.
        J Neurol Sci. 1994; 126: 232-236
        • Doherty M.J.
        • Spence D.P.
        • Young C.
        • Calverley P.M.
        Obstructive sleep apnoea with Arnold-Chiari malformation.
        Thorax. 1995; 50 (discussion 696-7): 690-691
        • Lam B.
        • Ryan C.F.
        Arnold-Chiari malformation presenting as sleep apnea syndrome.
        Sleep Med. 2000; 1: 139-144
        • Levitt P.
        • Cohn M.A.
        Sleep apnea and the Chiari I malformation: Case report.
        Neurosurgery. 1988; 23: 508-510
        • Miyamoto M.
        • Miyamoto T.
        • Hirata K.
        • Katayama S.
        A case of Arnold-Chiari Type I malformation presenting with dysrhythmic breathing during sleep.
        Psychiatry Clin Neurosci. 1998; 52: 212-216
        • Aarts L.A.
        • Willemsen M.A.
        • Vandenbussche N.L.
        • van Gent R.
        Nocturnal apnea in Chiari type I malformation.
        Eur J Pediatr. 2011; 170: 1349-1352
        • Brown B.J.
        • Habelt S.
        • Koral K.
        • Sacco D.
        • Herman J.H.
        • Baker L.A.
        Secondary nocturnal enuresis caused by central sleep apnea from Chiari malformation type 1.
        J Pediatr Urol. 2010; 6: 265-269
        • Murray C.
        • Seton C.
        • Prelog K.
        • Fitzgerald D.A.
        Arnold Chiari type 1 malformation presenting with sleep disordered breathing in well children.
        Arch Dis Child. 2006; 91: 342-343
        • Rabec C.
        • Laurent G.
        • Baudouin N.
        • et al.
        Central sleep apnoea in Arnold-Chiari malformation: evidence of pathophysiological heterogeneity.
        Eur Respir J. 1998; 12: 1482-1485
        • Shiihara T.
        • Shimizu Y.
        • Mitsui T.
        • Saitoh E.
        • Sato S.
        Isolated sleep apnea due to Chiari type I malformation and syringomyelia.
        Pediatr Neurol. 1995; 13: 266-267
        • Spence J.
        • Pasterkamp H.
        • McDonald P.J.
        Isolated central sleep apnea in type I Chiari malformation: Improvement after surgery.
        Pediatr Pulmonol. 2010; 45: 1141-1144
        • Van den Broek M.J.
        • Arbues A.S.
        • Chalard F.
        • et al.
        Chiari type I malformation causing central apnoeas in a 4-month-old boy.
        Eur J Paediatr Neurol. 2009; 13: 463-465
        • Miralbes Terraza S.
        • Garcia Oguiza A.
        • Lopez Pison J.
        • et al.
        [Central sleep apnea syndrome as the first sign of type I Chiari malformation].
        An Pediatr (Barc). 2008; 68: 277-281
        • Novegno F.
        • Caldarelli M.
        • Massa A.
        • et al.
        The natural history of the Chiari Type I anomaly.
        J Neurosurg Pediatr. 2008; 2: 179-187
        • Mikulis D.J.
        • Diaz O.
        • Egglin T.K.
        • Sanchez R.
        Variance of the position of the cerebellar tonsils with age: preliminary report.
        Radiology. 1992; 183: 725-728
        • Tran K.
        • Hukins C.A.
        Obstructive and central sleep apnoea in Arnold-Chiari malformation: resolution following surgical decompression.
        Sleep Breath. 2011; 15: 611-613
        • George T.M.
        • Higginbotham N.H.
        Defining the signs and symptoms of Chiari malformation type I with and without syringomyelia.
        Neurol Res. 2011; 33: 240-246
        • Milhorat T.H.
        • Chou M.W.
        • Trinidad E.M.
        • et al.
        Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients.
        Neurosurgery. 1999; 44: 1005-1017
        • McGirt M.J.
        • Nimjee S.M.
        • Fuchs H.E.
        • George T.M.
        Relationship of cine phase-contrast magnetic resonance imaging with outcome after decompression for Chiari I malformations.
        Neurosurgery. 2006; 59: 140-146

      Linked Article

      • Response to Losurdo et al.
        Pediatric NeurologyVol. 49Issue 5
        • Preview
          We would like to thank Losurdo et al. for their interest and comments on our article on magnetic resonance imaging findings and sleep apnea in patients with Chiari type 1 malformations,1 in addition to furnishing the relevant literature on sleep studies in Chiari type 1 malformation, which they have so elegantly summarized in their accompanying Table. This table supplies additional information on the topic to the journal's readership.
        • Full-Text
        • PDF
      • What Causes Sleep-Disordered Breathing in Chiari I Malformation? Comment on: “MRI Findings and Sleep Apnea in Children With Chiari I Malformation”
        Pediatric NeurologyVol. 49Issue 5
        • Preview
          Khatwa et al.,1 in their article entitled “MRI Findings and Sleep Apnea in Children With Chiari I Malformation,” addressed sleep-disordered breathing (SDB) in a cohort of children with Chiari type I malformation (CM-I), and delineated the relationships between clinical symptoms, polysomnographic findings, and neuroimaging. Moreover, the authors included in their cohort a subset of patients who underwent surgical decompression of the posterior fossa.
        • Full-Text
        • PDF