The Chiari I Abnormality in Childhood

 

abnormality-children3We found that if we broke the numbers down to below the age of 3 and above the age of 3, we came to some statistical significant conclusion. [see Figure 3] 10 of these patients out of the 45 had had a previous operation, but 6 of them had an operation which was not neurosurgical, but because they had problems with reflux, failure to thrive, difficulty with swallowing. They already had fundoplication (that means tacking up the stomach so that they dont regurgitate). Gastrostomy was for feeding, and because of difficulty with breathing and swallowing and aspiration; in other words, food going down the wrong way, and landing up with pneumonia. Two of them had previous tracheotomies, (that means an opening in the windpipe so that youre bypassing and making sure they dont have a problem as far as going the wrong way).

abnormality-children4Below the age of 6, maybe half complained of headaches. [see Figure 4] How does a child complain of headaches? Apart from being a pediatric neurosurgeon, Im a pediatric neurologist too, and one of the ways in which you can think of a child as having a problem is they run to mom and dad and they grab you and then they point to their tummy. Stomach pain in a child below the age of 3 may be manifestation of headaches. Many times they whine when they go to the bathroom to have a bowel movement because when theyre constipated theyre going to have to strain and have a valsalva headache.

If they strain then theyre going to increase their headache, so they become further constipated, its a vicious cycle. The next thing that happens is there is a hard stool that is coming through and they get a fissure that makes it more painful, so they scream before in anticipation both of the headache as well as now for the rectal fissure problem.
So headache was one, the next was repeated aspiration and pneumonia. Ill explain to you what repeated aspiration means. That means things going down the wind pipe, both liquid and solid but most of the time its liquid because in the food pipe, the pharynx has a chance to grab onto food, it can propel it down, but liquid (now Im not talking about yogurt or soft ice cream, Im talking with straight liquid) the pharynx doesnt have a chance to grab onto it, so it can go the wrong way.

Sleep apnea, you all know what sleep apnea is, meaning, you know there was a term that was used a long time ago called ondines curse and that was the curse of a woman whose lover jilted her and left for somebody else. She said that "when you sleep with somebody else youll fall asleep and you wont wake up, youll stop breathing."

Weakness and gait abnormalities. Now remember a child starts walking, starts cruising around at about 10 or 11 months of age and becomes steady on the feet only at about 2 years of age. They walk like they are on a boat, wide stance and then they are toddling around; we have to go past that normal phenomenon. Were talking about true gait abnormalities, a child who has already achieved independent walking and then has difficulty again; so a backward step.

Failure to thrive. Scoliosis is in about a third of the patients and then developmental delay because youve got nutritional factors that come in.

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