Pathophysiology of headache associated with cough in patients with Chiari I malformation

医学 脊髓空洞症 麻醉 Chiari畸形 外科 脑脊液压力 颅内低血压 脑脊液 蛛网膜下腔 病理生理学 咳嗽反射 颅内压 脊髓 内科学 反射 精神科
作者
Charles A. Sansur,John D. Heiss,Hetty L. DeVroom,Eric Eskioglu,Robert Ennis,Edward H. Oldfield
出处
期刊:Journal of Neurosurgery [American Association of Neurological Surgeons]
卷期号:98 (3): 453-458 被引量:117
标识
DOI:10.3171/jns.2003.98.3.0453
摘要

Object. The aim of this study was to evaluate the pathophysiology underlying headache associated with cough in patients with Chiari I tonsillar abnormality. The authors hypothesized that peak intrathecal pressure during coughing is higher in patients with headache aggravated by cough than in patients without or in healthy volunteers. In addition, the authors evaluated the use of intrathecal pressure during cough as a means of assessing obstruction to the free flow of cerebrospinal fluid (CSF) at the craniocervical junction. Methods. Twenty-six adult patients with Chiari I malformation and syringomyelia, four adult patients with Chiari I malformation without syringomyelia, and 15 healthy volunteers were prospectively studied. Testing before surgery included the following: 1) clinical evaluation for the presence of headache associated with cough; and 2) evaluation of lumbar subarachnoid pressure at rest, during three to five coughs, while performing the Valsalva maneuver, during jugular compression, and after removal of CSF. Patients underwent suboccipital craniectomy, C-1 laminectomy, and duraplasty. Testing was repeated 6 months after surgery. Conclusions. Peak intrathecal pressures during cough and at baseline were elevated in patients with headache associated with cough compared with either patients without headache or healthy volunteers. After surgery, intrathecal pressures during cough were significantly lower than preoperative values and headache aggravated by cough was resolved partially or completely. Headache linked to coughing in patients with Chiari I malformation is associated with sudden increased intrathecal pressure caused by obstruction to the free flow of CSF in the subarachnoid space.
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