Syncope in the adult Chiari anomaly

Area of Science:

• Neurology
• Neurosurgery
• Physiology

Background:

• Adult Chiari malformation is a structural defect in the cerebellum.
• This condition can lead to various neurological symptoms.

Observation:

• A patient with adult Chiari malformation experienced syncopal episodes during mild exertion.
• These episodes were characterized by electroencephalogram (EEG) slowing but stable vital signs.

Findings:

• Attacks were reproducible with exercise, jugular vein compression, and Valsalva maneuver.
• The syncope was attributed to transient increases in intracranial pressure.
• Increased intracranial pressure likely caused dysfunction of the ascending reticular activating system.

Implications:

• This suggests a mechanism for exertional syncope in Chiari malformation patients.
• Understanding this mechanism may guide diagnostic and therapeutic strategies.
• Further research is needed to confirm the role of intracranial pressure in these events.