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Transient Decrease in Cerebrospinal Fluid Motion Is Related to Cough-Associated Headache in Chiari I Malformation.

Rafeeque A Bhadelia1, Alaaddin Ibrahimy2, Mohamad Motaz Al Samman3

  • 1Department of Radiology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA.

World Neurosurgery
|July 4, 2024
PubMed
Summary
This summary is machine-generated.

Cough-associated headache in Chiari I malformation patients is linked to reduced cerebrospinal fluid flow after coughing. This finding supports the theory of worsened obstruction at the foramen magnum.

Keywords:
Chiari I malformationCough headacheMRI

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Area of Science:

  • Neurology
  • Neurosurgery
  • Medical Imaging

Background:

  • Chiari I malformation (CMI) is associated with cough-associated headache (CAH).
  • CAH is hypothesized to result from temporary obstruction of cerebrospinal fluid (CSF) flow at the foramen magnum during coughing.

Purpose of the Study:

  • To investigate changes in CSF flow during coughing in CMI patients with and without CAH.
  • To compare CSF flow dynamics between CMI patients and healthy participants.

Main Methods:

  • Real-time magnetic resonance imaging (MRI) using a pencil-beam sequence was employed.
  • Cerebrospinal fluid stroke volume (SVCSF) was measured at the craniocervical junction in CMI patients with CAH, CMI patients without CAH, and healthy participants.
  • Measurements were taken during resting, post-coughing, and relaxation phases.

Main Results:

  • Post-coughing SVCSF was significantly reduced in CMI patients with CAH compared to those without CAH and healthy participants.
  • No significant differences in post-coughing SVCSF were observed between CMI patients without CAH and healthy participants.
  • CSF flow dynamics at rest and during relaxation showed minimal differences between groups.

Conclusions:

  • Reduced CSF flow after coughing in CMI patients with CAH supports the hypothesis of transiently worsened CSF flow obstruction.
  • The findings provide evidence for the mechanism underlying CAH in the context of Chiari I malformation.