1
|
García M, Amayra I, Pérez M, Rodríguez AA, Salgueiro M, Infante J. Impact of chronic pain and depressive symptoms on the quality of life of adults with Chiari Malformation type I: A comparative study. Intractable Rare Dis Res 2024; 13:148-156. [PMID: 39220278 PMCID: PMC11350206 DOI: 10.5582/irdr.2024.01010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2024] [Revised: 06/11/2024] [Accepted: 06/24/2024] [Indexed: 09/04/2024] Open
Abstract
Chiari Malformation type I (CM-I) is a neurological disorder characterized by cerebellar tonsillar herniation. Chronic pain, particularly headaches, is a prevalent symptom in CM-I patients, significantly impacting their quality of life. The objective of this study was to evaluate the perceived quality of life in adults with CM-I and examine the influence of chronic pain and comorbid symptoms on their well-being. 26 CM-I patients (8 with decompressive surgery) and 26 matched healthy controls were recruited. Participants completed the following questionnaires: WHOQOL-BREF, HDI, NDI, OLBPDQ and HADS. CM-I patients exhibited significantly lower scores across all domains of quality of life when compared to healthy controls. Chronic pain, including headache, neck pain, and low back pain, was more pronounced among CM-I patients and demonstrated a significant correlation with depressive symptoms. Notably, after controlling for chronic pain, the differences in quality of life between CM-I patients and controls diminished. The results suggest that chronic pain, especially headaches, and comorbid depressive symptoms exert a substantial impact on the quality of life of CM-I patients. Surgical intervention alone may not fully address these issues, highlighting the importance of considering psychological interventions as part of the comprehensive treatment. Further research with larger samples and pre-post-surgery assessments is needed to validate these findings and explore the potential benefits of psychological therapies in enhancing the quality of life for CM-I patients.
Collapse
Affiliation(s)
- Maitane García
- Neuro-e-Motion Research Team, Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Imanol Amayra
- Neuro-e-Motion Research Team, Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Manuel Pérez
- Faculty of Health Sciences, Isabel I University, Burgos, Spain
| | - Alicia Aurora Rodríguez
- Neuro-e-Motion Research Team, Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
| | - Monika Salgueiro
- Neuro-e-Motion Research Team, Department of Psychology, Faculty of Health Sciences, University of Deusto, Bilbao, Spain
- Department of Clinical and Health Psychology, and Research Methodology, Faculty of Psychology, University of the Basque Country UPV/EHU, Donostia, Spain
| | - Jon Infante
- Neurology Service, University Hospital Marqués de Valdecilla-IDIVAL, Centro de Investigación Biomédica en Red de Enfermedades Neurodegenerativas (CIBERNED), University of Cantabria, Santander, Spain
| |
Collapse
|
2
|
He Y, Tao Y, Tian J, Bao M, Zhang M, Huang Q, Li H, Chang X, Li K, Liu P, Guo L, Qin X, Huang C, Wu B. Unveiling the domino effect: a nine-year follow-up on pentalogy of central nervous system induced by a large unruptured cerebral arteriovenous malformation: a case report and literature review. Front Neurol 2024; 15:1365525. [PMID: 38846033 PMCID: PMC11153792 DOI: 10.3389/fneur.2024.1365525] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Accepted: 04/22/2024] [Indexed: 06/09/2024] Open
Abstract
Background The disruption of intracranial fluid dynamics due to large unruptured cerebral arteriovenous malformation (AVM) commonly triggers a domino effect within the central nervous system. This phenomenon is frequently overlooked in prior clinic and may lead to catastrophic misdiagnoses. Our team has documented the world's first case of so-called AVM Pentalogy (AVMP) induced by a AVM. Clinical presentation and result A 30-year-old female was first seen 9 years ago with an occasional fainting, at which time a huge unruptured AVM was discovered. Subsequently, due to progressive symptoms, she sought consultations from several prestigious neurosurgical departments in China, where all consulting neurosurgeons opted for conservation treatment due to perceived surgical risks. During the follow-up period, the patient gradually presented with hydrocephalus, empty sella, secondary Chiari malformation, syringomyelia, and scoliosis (we called as AVMP). When treated in our department, she already displayed numerous symptoms, including severe intracranial hypertension. Our team deduced that the hydrocephalus was the primary driver of her AVMP symptoms, representing the most favorable risk profile for intervention. As expected, a ventriculoperitoneal shunt successfully mitigated all symptoms of AVMP at 21-months post-surgical review. Conclusion During the monitoring of unruptured AVM, it is crucial to remain vigilant for the development or progression of AVMP. When any component of AVMP is identified, thorough etiological studies and analysis of cascade reactions are imperative to avert misdiagnosis. When direct AVM intervention is not viable, strategically addressing hydrocephalus as part of the AVMP may serve as the critical therapeutic focus.
Collapse
Affiliation(s)
- Yunsen He
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital and Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu, China
| | - Ye Tao
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Jing Tian
- Department of Neurosurgery, The People’s Hospital of Zhongjiang, Deyang, Sichuan, China
| | - Mingbin Bao
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Mengjun Zhang
- Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Qinjiang Huang
- Department of Neurosurgery, Wenjiang District People’s Hospital of Chengdu, Chengdu, China
| | - Hongliang Li
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital and Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu, China
| | - Xinxin Chang
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital and Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu, China
| | - Kun Li
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital and Shanghai Lansheng Brain Hospital Investment Co., Ltd., Chengdu, China
| | - Ping Liu
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Lili Guo
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Xiaohong Qin
- Department of Neurosurgery, The People’s Hospital of Zhongjiang, Deyang, Sichuan, China
| | - Caiquan Huang
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| | - Bo Wu
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, Sichuan, China
| |
Collapse
|
3
|
Bao M, He Y, Tao Y, Liu L, Li Y, Zhu Y, Huang Q, Zhang M, Wu B, Wang H. Large vestibular schwannomas presenting in the late state of pregnancy: a case report and literature review. Front Neurol 2023; 14:1270989. [PMID: 38107637 PMCID: PMC10722247 DOI: 10.3389/fneur.2023.1270989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 11/07/2023] [Indexed: 12/19/2023] Open
Abstract
Vestibular schwannomas in pregnancy have rarely been reported, and there is a lack of in-depth discussion on the experience of management of massive acoustic neuromas in pregnancy. Herein, we present a pregnant woman with a giant vestibular schwannoma and obstructive hydrocephalus who presented at 30 weeks of gestation. She was initially misdiagnosed as having a pregnancy-related reaction of headache, dizziness, and vomiting that had occurred 2 months earlier. After observation at home, her symptoms progressed at 30 weeks of gestation, and imaging findings revealed a brain tumor in the CPA region with secondary cerebella tonsil herniation and obstructive hydrocephalus, and she was transferred to our center for treatment. Consequently, we relieved her hydrocephalus with a ventriculoperitoneal shunt (V-P shunt) and used corticosteroids to simulate fetal maturation. After 10 days, her mental condition deteriorated, and her right limb muscle strength gradually decreased until grade 0 (MMT Grading). Finally, under a joint consultation with the Department of Neurosurgery, Obstetrics, and Anesthesiology, she underwent a cesarean section under general anesthesia and first-stage tumor removal at 31 weeks of gestation. Upon discharge, the previously observed neurological deficits, which were reversible and had manifested during her gestational period, had been successfully resolved, and the fetus had been conserved. The neuroimaging confirmed the complete tumor removal, while the neuropathologic examination revealed a vestibular schwannoma. Therefore, we recommend early diagnosis and treatment for these patients, especially people with headaches, vomiting, and sudden hearing loss during pregnancy. Herein, we concluded that our cases provide a valuable experience in the latest acceptable time frame for the operation to prevent irreversible neurological impairment and premature delivery in late pregnancy.
Collapse
Affiliation(s)
- Mingbin Bao
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yunsen He
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital & Shanghai Lansheng Brain Hospital Investment Co., Ltd, Chengdu, China
| | - Ye Tao
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Li Liu
- Department of Imaging, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yuheng Li
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Yongjun Zhu
- Department of Neurosurgery, Suining Municipal Hospital of TCM, Suining, China
| | - Qinjiang Huang
- Department of Neurosurgery, Wenjiang District People’s Hospital of Chengdu, Chengdu, China
| | - Mengjun Zhang
- Department of Psychiatry, Sichuan Provincial Center for Mental Health, University of Electronic Science and Technology of China, Chengdu, China
| | - Bo Wu
- Department of Neurosurgery, Sichuan Provincial People’s Hospital, University of Electronic Science and Technology of China, Chengdu, China
| | - Hao Wang
- Department of Neurosurgery, Jianyang Chinese Medicine Hospital, Chengdu, China
| |
Collapse
|
4
|
He Y, Zhang M, Qin X, Huang C, Liu P, Tao Y, Wang Y, Guo L, Bao M, Li H, Mao Z, Li N, He Z, Wu B. Research process, recap, and prediction of Chiari malformation based on bicentennial history of nomenclature and terms misuse. Neurosurg Rev 2023; 46:316. [PMID: 38030943 DOI: 10.1007/s10143-023-02207-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 10/15/2023] [Accepted: 10/29/2023] [Indexed: 12/01/2023]
Abstract
There is an absent systematic analysis or review that has been conducted to clarify the topic of nomenclature history and terms misuse about Chiari malformations (CMs). We reviewed all reports on terms coined for CMs for rational use and provided their etymology and future development. All literature on the nomenclature of CMs was retrieved and extracted into core terms. Subsequently, keyword analysis, preceding and predicting (2023-2025) compound annual growth rate (CAGR) of each core term, was calculated using a mathematical formula and autoregressive integrated moving average model in Python. Totally 64,527 CM term usage was identified. Of these, 57 original terms were collected and then extracted into 24 core-terms. Seventeen terms have their own featured author keywords, while seven terms are homologous. The preceding CAGR of 24 terms showed significant growth in use for 18 terms, while 13, three, three, and five terms may show sustained growth, remain stable, decline, and rare in usage, respectively, in the future. Previously, owing to intricate nomenclature, Chiari terms were frequently misused, and numerous seemingly novel but worthless even improper terms have emerged. For a very basic neuropathological phenomenon tonsillar herniation by multiple etiology, a mechanism-based nosology seems to be more conducive to future communication than an umbrella eponym. However, a good nomenclature also should encapsulate all characteristics of this condition, but this is lacking in current CM research, as the pathophysiological mechanisms are not elucidated for the majority of CMs.
Collapse
Affiliation(s)
- Yunsen He
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital & Shanghai Lansheng Brain Hospital Investment Co., Ltd., 6 Anrong Road, Chadianzi Street, Jinniu District, Chengdu, 610036, Sichuan, China
| | - Mengjun Zhang
- Department of Neuropsychology, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Xiaohong Qin
- Department of Neuropsychology, Sichuan Provincial Center for Mental Health, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Caiquan Huang
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China
| | - Ping Liu
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China
| | - Ye Tao
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China
| | - Yishuang Wang
- Department of Radiology, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, Chengdu, 610072, China
| | - Lili Guo
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China
| | - Mingbin Bao
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China
| | - Hongliang Li
- Department of Neurosurgery, Sichuan Lansheng Brain Hospital & Shanghai Lansheng Brain Hospital Investment Co., Ltd., 6 Anrong Road, Chadianzi Street, Jinniu District, Chengdu, 610036, Sichuan, China
| | - Zhenzhen Mao
- Emergency Department, Sichuan Taikang Hospital, Chengdu, 610000, Sichuan, China
| | - Nanxiang Li
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China
| | - Zongze He
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China.
| | - Bo Wu
- Department of Neurosurgery, Sichuan Provincial People's Hospital, University of Electronic Science and Technology of China, No.32, West Section 2, First Ring Road, Chengdu, 610072, Sichuan, China.
| |
Collapse
|