title: Chiari syndrome and respiratory failure: a literature review.
abstract: BACKGROUND
  Patients with failed extubation requiring reintubation have increased morbidity and mortality. This situation may reflect the severity of the underlying disorder or may reflect an undiagnosed condition that was not apparent at the time of the initial intubation.
  
  
  METHODS
  Case report and literature review.
  
  
  RESULTS
  A 49-year-old man developed acute hypercapneic respiratory failure during an episode of community-acquired pneumonia. This patient failed extubation 4 times. Routine neurological evaluation, including computed tomography of the head, was within normal limits. A magnetic resonance imaging revealed a severe Chiari malformation type I. The patient eventually required tracheostomy and prolonged mechanical ventilation. We identified 28 cases with Chiari malformations (CM) in the medical literature, who presented with respiratory failure. The mean age was 29.5 years, 46% of the cases were male, 50% had an associated syringomyelia, and 64% required a decompressive surgery. Twenty-five percent had recurrent symptoms postsurgery.
  
  
  CONCLUSIONS
  Patients with CMs can have repeated extubation failures. Some of these patients have normal neurological examinations and studies and are not identified until they have an MRI study. Clinicians need to consider this possibility in patients who are difficult to wean.
authors.affiliation: Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA.
authors.forename: Kunut
authors.initials: K
authors.lastname: Kijsirichareanchai
authors.affiliation: Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA.
authors.forename: Chok
authors.initials: C
authors.lastname: Limsuwat
authors.affiliation: Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA.
authors.forename: Charoen
authors.initials: C
authors.lastname: Mankongpaisarnrung
authors.affiliation: Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA.
authors.forename: Nopakoon
authors.initials: N
authors.lastname: Nantsupawat
authors.affiliation: Department of Internal Medicine, Texas Tech Health Sciences Center, Lubbock, TX, USA kenneth.nugent@ttuhsc.edu.
authors.forename: Kenneth
authors.initials: K
authors.lastname: Nugent
mesh_terms: D001139:Arnold-Chiari Malformation / Q000150:complications*; D003952:Diagnostic Imaging; D006801:Humans; D007442:Intubation, Intratracheal; D008297:Male; D008875:Middle Aged; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology* / Q000628:therapy*; D014139:Tracheostomy
keywords: Chiari malformation; apnea; extubation; mechanical ventilation