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Chiari type I malformation, glossopharyngeal neuralgia and central sleep apnoea in a child
A Yglesias1, J Narbona, V Vanaclocha
1Departamento de Pediatría, Facultad de Medicina, Universidad de Navarra, Pamplona, Spain.
Insights
This case study details an 8-year-old child with central sleep apnea and glossopharyngeal neuralgia, linked to Chiari type I malformation. Surgical decompression successfully resolved both conditions, highlighting a potential compressive mechanism.
Area of Science:
- Pediatric Neurology
- Neurosurgery
- Sleep Medicine
Background:
- Chiari type I malformation is a structural defect in the cerebellum.
- Sleep-disordered breathing and cranial nerve issues can occur in neurological conditions.
- Glossopharyngeal neuralgia involves severe facial pain.
Observation:
- An 8-year-old presented with central sleep apnea and glossopharyngeal neuralgia.
- MRI revealed Chiari type I malformation with syringomyelia and a cystic collection.
- Polysomnography confirmed frequent central sleep apneas.
Findings:
- Surgical decompression of the cranio-cervical junction provided immediate relief from apnea and neuralgia.
- Post-operative MRI showed resolution of the syringomyelic cavity.
- The child remained asymptomatic two years after surgery.
Implications:
- This case suggests a compressive etiology for sleep apnea and glossopharyngeal neuralgia in pediatric Chiari type I malformation.
- Cranio-cervical decompression is an effective treatment for these associated symptoms.
- Highlights the importance of considering Chiari malformation in children with unexplained neurological and sleep disorders.
Abstract:
We describe the case of an 8-year-old child who presented with sleep breathing disorders associated with glossopharyngeal neuralgia. Polysomnographic studies showed central sleep apnoea lasting 10 to 18 seconds in an average frequency of 63 times for every hour of sleep. Magnetic resonance imaging (MRI) studies showed a caudal displacement of the cerebellar tonsils down to C3 level, associated with a syringomyelic cavity in the upper cervical cord and an extramedullary cystic collection at C2. Surgical decompression of the cranio-cervical junction completely relieved the apnoea and the glossopharyngeal neuralgia immediately following the procedure. MRI study performed one month later showed the complete disappearance of the syringomyelic cavity. Two years later this child remains asymptomatic. In childhood the association of Chiari type I malformation with sleep apnoea and glossopharyngeal neuralgia has not been previously reported. The successful outcome after surgery suggests a compressive mechanism on the brainstem and on the IX cranial nerve to explain these two clinical features in our patient.