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[The anesthetic management of Arnold-Chiari malformation with spinal cord injury]
Y Saitoh1, T Ohshima, K Ichikawa
1Department of Anesthesiology and Critical Care Medicine, Tokyo Medical and Dental University School of Medicine.
Abstract:
A rare case of spinal cord injury at C3 level associated with Arnold-Chiari malformation is reported. A 33 year old male was admitted with a complaint of walking difficulty. MRI revealed cerebellar herniation, and a plain X-ray showed spinous process adhesion of C2-3 and slight scoliosis. Percent vital capacity was reduced to 69%, and blood cell count showed a slight anemia. The patient was anesthetized for an orthopedic surgery with pethidine 70 mg, thiamylal 200 mg, 60% nitrous oxide, 40% oxide, and 0.5-1.2% isoflurane. There was a mild decrease in arterial blood pressure during surgical procedures, but this could be easily treated by fluid therapy, and there was no episode of autonomic hyperreflexia. Postoperative course of the patient was uneventful, except a transient pneumonia and urinary tract infection. The key in the anesthetic management of Arnold-Chiari malformation with spinal cord injury is the control of intracranial pressure, care for respiratory dysfunction and the prevention of infection as well as autonomic hyperreflexia.
Insights
This case report details managing a rare spinal cord injury at C3 with Arnold-Chiari malformation. Anesthetic management focused on controlling intracranial pressure and preventing complications like autonomic hyperreflexia.
Area of Science:
- Neurosurgery
- Anesthesiology
- Neurology
Background:
- Arnold-Chiari malformation (ACM) can cause neurological deficits.
- Spinal cord injury (SCI) presents unique anesthetic challenges.
Observation:
- A 33-year-old male with C3 SCI and ACM presented with gait difficulties.
- Imaging revealed cerebellar herniation, C2-3 spinous process adhesion, and mild scoliosis.
- Reduced vital capacity (69%) and mild anemia were noted.
Findings:
- Anesthetic management involved pethidine, thiamylal, nitrous oxide, and isoflurane.
- Mild hypotension occurred but was managed with fluid therapy.
- No autonomic hyperreflexia was observed during surgery.
Implications:
- Key anesthetic considerations include intracranial pressure control, respiratory support, and infection prevention.
- Careful management is crucial for patients with ACM and SCI to prevent autonomic hyperreflexia and ensure a favorable outcome.