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Makoshi Z, Leonard JR. Clinical Manifestations of Chiari I Malformation. Neurosurg Clin N Am 2023; 34:25-34. [DOI: 10.1016/j.nec.2022.09.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Ibrahimy A, Huang CWC, Bezuidenhout AF, Allen PA, Bhadelia RA, Loth F. Association Between Resistance to Cerebrospinal Fluid Flow Near the Foramen Magnum and Cough-Associated Headache in Adult Chiari Malformation Type I. J Biomech Eng 2021; 143:051003. [PMID: 33454731 PMCID: PMC8086178 DOI: 10.1115/1.4049788] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 12/18/2020] [Indexed: 01/03/2023]
Abstract
Cough-associated headaches (CAHs) are thought to be distinctive for Chiari malformation type I (CMI) patients and have been shown to be related to the motion of cerebrospinal fluid (CSF) near the foramen magnum (FM). We used computational fluid dynamics (CFD) to compute patient-specific resistance to CSF motion in the spinal canal for CMI patients to determine its accuracy in predicting CAH. Fifty-one symptomatic CMI patients with cerebellar tonsillar position (CTP) ≥ 5 mm were included in this study. The patients were divided into two groups based on their symptoms (CAH and non-CAH) by review of the neurosurgical records. CFD was utilized to simulate CSF motion, and the integrated longitudinal impedance (ILI) was calculated for all patients. A receiver operating characteristic (ROC) curve was evaluated for its accuracy in predicting CAH. The ILI for CMI patients with CAH (776 dyn/cm5, 288-1444 dyn/cm5; median, interquartile range) was significantly larger compared to non-CAH (285 dyn/cm5, 187-450 dyn/cm5; p = 0.001). The ILI was more accurate in predicting CAH in CMI patients than the CTP when the comparison was made using the area under the ROC curve (AUC) (0.77 and 0.70, for ILI and CTP, respectively). ILI ≥ 750 dyn/cm5 had a sensitivity of 50% and a specificity of 95% in predicting CAH. ILI is a parameter that is used to assess CSF blockage in the spinal canal and can predict patients with and without CAH with greater accuracy than CTP.
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Affiliation(s)
- Alaaddin Ibrahimy
- Department of Mechanical Engineering, The University of Akron, 302 E Buchtel Avenue, Akron, OH 44325
| | - Chi-Wen Christina Huang
- Department of Radiology, Wan Fang Hospital, Taipei Medical University, No. 250, Wuxing Street, Xinyi District, Taipei City 110, Taiwan
| | - Abraham F. Bezuidenhout
- Beth Israel Deaconess Medical Center, Department of Radiology, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215
| | - Philip A. Allen
- Department of Psychology, The University of Akron, 302 E Buchtel Avenue, Akron, OH 44325
| | - Rafeeque A. Bhadelia
- Beth Israel Deaconess Medical Center, Department of Radiology, Harvard Medical School, 330 Brookline Avenue, Boston, MA 02215
| | - Francis Loth
- Department of Mechanical Engineering, The University of Akron, 302 E Buchtel Avenue, Akron, OH 44325
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Naime S, Batra SK, Fiorillo C, Collins ME, Gatti M, Krakovsky GM, Sehgal S, Bauman NM, Pillai DK. Aerodigestive Approach to Chronic Cough in Children. ACTA ACUST UNITED AC 2018; 4:467-479. [PMID: 30859056 DOI: 10.1007/s40746-018-0145-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Abstract
Purpose of review Chronic cough is the most common presenting complaint in a pediatric aerodigestive clinic. The etiology of chronic cough is varied and often includes more than one organ system. This review aims to summarize the current literature for a multidisciplinary approach when evaluating a child with chronic cough. Recent findings There is very little medical literature focused on a multidisciplinary approach to chronic cough. In the limited data available, multidisciplinary clinics have been shown to be more cost-efficient for the families of children with complex medical problems, and also increase the likelihood of successfully obtaining a diagnosis. Summary There is no consensus in the literature on how to work-up a child with chronic cough presenting to an aerodigestive clinic. Current studies from these clinics have shown improved outcomes related to cost-effectiveness and identifying definitive diagnoses. Future studies evaluating clinical outcomes are necessary to help delineate the utility of testing routinely performed, and to demonstrate the impact of interventions from each specialty on quality of life and specific functional outcome measures.
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Affiliation(s)
- Samira Naime
- Department of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA.
| | - Suruchi K Batra
- Department of Gastroenterology, Hepatology, and Nutrition, Children's National Health System, Washington, DC, USA.
| | - Caitlin Fiorillo
- Department of Otolaryngology-Head and Neck Surgery, Children's National Health System, Washington, DC, USA.
| | - Maura E Collins
- Department of Hearing and Speech, Children's National Health System, Washington, DC, USA.
| | - Meagan Gatti
- Department of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA.
| | - Gina M Krakovsky
- Department of Otolaryngology-Head and Neck Surgery, Children's National Health System, Washington, DC, USA.
| | - Sona Sehgal
- Department of Gastroenterology, Hepatology, and Nutrition, Children's National Health System, Washington, DC, USA.
| | - Nancy M Bauman
- Department of Otolaryngology-Head and Neck Surgery, Children's National Health System, Washington, DC, USA.
| | - Dinesh K Pillai
- Department of Pulmonary and Sleep Medicine, Children's National Health System, Washington, DC, USA
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Lai K, Shen H, Zhou X, Qiu Z, Cai S, Huang K, Wang Q, Wang C, Lin J, Hao C, Kong L, Zhang S, Chen Y, Luo W, Jiang M, Xie J, Zhong N. Clinical Practice Guidelines for Diagnosis and Management of Cough-Chinese Thoracic Society (CTS) Asthma Consortium. J Thorac Dis 2018; 10:6314-6351. [PMID: 30622806 PMCID: PMC6297434 DOI: 10.21037/jtd.2018.09.153] [Citation(s) in RCA: 56] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2018] [Accepted: 09/10/2018] [Indexed: 12/26/2022]
Affiliation(s)
- Kefang Lai
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Huahao Shen
- The Second Hospital Affiliated to Medical College of Zhejiang University, Hangzhou 310009, China
| | - Xin Zhou
- Shanghai Jiaotong University Affiliated Shanghai No. 1 People’s Hospital, Shanghai 200080, China
| | - Zhongmin Qiu
- Tongji Affiliated Tongji Hospital, Shanghai 200065, China
| | - Shaoxi Cai
- Southern Medical University Affiliated Nanfang Hospital, Guangzhou 510515, China
| | - Kewu Huang
- Capital Medical University Affiliated Beijing Chaoyang Hospital, Beijing 100020, China
| | | | - Changzheng Wang
- Xinqiao Hospital, Third Military Medical University, Chongqing 400037, China
| | - Jiangtao Lin
- China-Japan Friendship Hospital, Beijing 100029, China
| | - Chuangli Hao
- Children’s Hospital of Soochow University, Suzhou 215025, China
| | - Lingfei Kong
- The First Hospital of China Medical University, Shenyang 110001, China
| | - Shunan Zhang
- China-Japan Friendship Hospital, Beijing 100029, China
| | - Yaolong Chen
- Evidence-based Medical Center of Lanzhou University, Lanzhou 730000, China
| | - Wei Luo
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Mei Jiang
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Jiaxing Xie
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
| | - Nanshan Zhong
- State Key Laboratory of Respiratory Diseases, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou Institute of Respiratory Health, Guangzhou 510120, China
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Pindrik J, Johnston JM. Clinical Presentation of Chiari I Malformation and Syringomyelia in Children. Neurosurg Clin N Am 2015; 26:509-14. [PMID: 26408059 DOI: 10.1016/j.nec.2015.06.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Chiari I malformation and syringomyelia may be associated with a wide spectrum of symptoms and signs in children. Clinical presentations vary based on patient age and relative frequency; some diagnoses represent incidental radiographic findings. Occipitocervical pain, propagated or intensified by Valsalva maneuvers (or generalized irritability in younger patients unable to communicate verbally), and syringomyelia with or without scoliosis are the most common clinical presentations. Cranial nerve or brainstem dysfunction also may be observed in younger patients, and is associated with more complex deformity that includes ventral compression secondary to basilar invagination, retroflexion of the dens, and/or craniocervical instability.
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Affiliation(s)
- Jonathan Pindrik
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama, Birmingham (UAB), 1600 7th Avenue South, Lowder 400, Birmingham, AL 35233, USA
| | - James M Johnston
- Division of Pediatric Neurosurgery, Department of Neurosurgery, Children's of Alabama, University of Alabama, Birmingham (UAB), 1600 7th Avenue South, Lowder 400, Birmingham, AL 35233, USA.
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