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'Sneeze syncope', basilar invagination and Arnold-Chiari type I malformation
Journal of Neurology, Neurosurgery, and Psychiatry
|April 1, 1976
Summary
Sneezing can cause syncope in individuals with Arnold-Chiari type I malformation and basilar invagination. These conditions make the brain intolerant to pressure changes from the Valsalva maneuver.
Area of Science:
- Neurology
- Neurosurgery
- Pathological Anatomy
Background:
- Valsalva-related syncope is a recognized phenomenon.
- Arnold-Chiari type I malformation and basilar invagination are structural abnormalities of the skull base and cerebellum.
Observation:
- A case of syncope precipitated by sneezing in an adult male is presented.
- The patient had an associated Arnold-Chiari type I malformation and basilar invagination.
Findings:
- An acute clivoaxial angle, small foramen magnum, and type I Arnold-Chiari malformation create a combination of features intolerant to Valsalva-induced changes.
- These changes affect cerebral volume, brain-stem position, cerebrospinal fluid dynamics, and blood vessel relationships.
Implications:
- This case highlights the importance of considering structural abnormalities in the differential diagnosis of Valsalva-related syncope.
- Understanding the mechanisms of pressure transmission in these anatomical variations is crucial for patient management.