Surgery for Arnold–Chiari malformation associated with persistent atrial fibrillation: case history
I.M. Gilemkhanova1,2, Sh.M. Safin1,2, Kh.P. Derevyanko1
1Bashkir State Medical University, Ufa
2Republican Children’s Clinical Hospital, Ufa
Arnold–Chiari malformation is a group of congenital malformations of the posterior encephalon affecting structural relations between cerebellum, brainstem, upper cervical spinal cord, and bones of the skull base. Sporadic published data on Arnold–Chiari malformation associated with cardiac rhythm disturbances are available. This paper describes authors’ case history of Arnold–Chiari malformation associated with syringomyelia, retrocerebellar cyst, and tachyarrhythmia uncontrollable by medications in a 49-year-old woman. The woman was observed by therapist and cardiologist for abnormal heart rhythm (disease duration 6 years). She was presented with novel complaints of temporary loss of consciousness, dizziness, and abnormal coordination which required additional neurological diagnostics. After neurosurgery, cardiac rhythm has restored, neurological signs have regressed.
This case history demonstrates that Arnold–Chiari malformation can result in abnormal heart rhythm. Clinically, craniovertebral junction disorders should be excluded in patients with cardiac arrhythmias uncontrollable by medications in association with neurological signs. Early management of craniovertebral junction disorders provides complete resolution of cardiac disorder.
Keywords: Arnold–Chiari malformation, syringomyelia, retrocerebellar cyst, cardiac rhythm disorders.
For citation: Gilemkhanova I.M., Safin Sh.M., Derevyanko Kh.P. Surgery for Arnold–Chiari malformation associated with persistent atrial fibrillation: case history. RMJ. Medical Review. 2019;11(I):31–33.
2. Воронов В.Г., Зябров А.А., Иванов А.А., Потемкина Е.Г. Классификация заболеваний позвоночника и спинного мозга у детей. Нейрохирургия и неврология детского возраста. 2010;3–4(25–26):42–52. [Voronov V.G., Zyabrov A.A., Ivanov A.A., Potemkina E.G. Classification of diseases of the spine and spinal cord in children. Pediatric Neurosurgery and Neurology. 2010;3–4(25–26):42–52 (in Russ.)].
3. Кузбеков А.Р., Магжанов Р.В., Сафин Ш.М. Современные представления о мальформации Киари. Медицинский вестник Башкортостана. 2011;6(6):118–125. [Kuzbekov A.R., Magzhanov R.V., Safin Sh.M. Modern views on Chiari malformation. Medical Bulletin of Bashkortostan. 2011;6(6):118–125 (in Russ.)].
4. Крупина Н.Е. Сведения о семейных случаях сирингомиелии, базилярной импрессии и мальформации Киари. Неврологический вестник. 2001;1–2:70–75. [Krupina N.E. Data on family cases of syringomyelia, basilar impression and Chiari malformation. Neurology Bulletin. 2001;1–2:70–75 (in Russ.)].
5. Milhorat T.H. et al. Mechanisms of cerebellar tonsil herniation in patients with Chiari malformations as guide to clinical management. Acta neurochirurgica. 2010;152(7):1117–1127. DOI: 10.1007/s00701-010-0636-3.
6. Fernández A.A., Guerrero A.I., Martínez M.I. et al. Malformations of the craniocervical junction (Chiari type I and syringomyelia: classification, diagnosis and treatment). BMC Musculoskeletal disorders. 2009;10(1): S1. DOI: 10.1186/1471-2474-10-S1-S.
7. Севостьянов Д.В. Мальформация Киари I типа: патогенез, диагностика, хирургическое лечение (обзор литературы). Вестник уральской медицинской академической науки. 2011;1:63–64. [Sevostyanov D.V. Chiari Malformation type I: pathogenesis, diagnosis, surgical treatment (literature review). Bulletin of the Ural medical academic science. 2011;1:63–64 (in Russ.)].
8. Ветрилэ С.Т., Колесов С.В. Краниовертебральная патология. М.: Медицина; 2007. [Vetryle S.T., Kolesov S.V. Cranio-vertebral pathology. M.: Medicine; 2007 (in Russ.)].
9. Bejjani G.K. Definition of the adult Chiari malformation: a brief historical overview. Neurosurgical focus. 2001;11(1):1–8. DOI: 10.3171/foc.2001.11.1.2.
10. 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. DOI: 10.1136/jnnp.2004.048330.
11. Elia C., Brazdzionis J., Tashjian V. Resolution of tachyarrhythmia following posterior fossa decompression surgery for Chiari malformation type I: A case report. World Neurosurgery. 2018;111:154–156. DOI: 10.1016/j.wneu.2017.12.119.
This work is licensed under a Creative Commons «Attribution» 4.0 License.
