title: Chiari I malformation associated with atlanto-occipital assimilation presenting as orthopnea and cough syncope: a case report and review of literature.
abstract: Although it is not uncommon for patients with Chiari I malformations to present with respiratory complaints, cough syncope is a rare presenting symptom. We report an adult patient who harbored both a Chiari I malformation and atlanto-occipital assimilation who complained of cough syncope, orthopnea, and central sleep apnea. The patient underwent decompressive craniectomy of the posterior fossa and cervical level 2 laminectomy. However, due to a possible initial underappreciation of the profound narrowing of the foramen magnum as a result of these concomitant pathologies, the patient may have had continued impaired cerebrospinal fluid flow, leading to a symptomatic pseudomeningocele and requiring a more extensive decompression that included a cervical level 3 laminectomy as well as a temporary lumbar drain. On 2-year follow-up, he has remained asymptomatic.
authors.affiliation: Department of Neurosurgery, Rush Professional Office Building, Chicago, Illinois, United States.
authors.forename: Erwin Zeta
authors.initials: EZ
authors.lastname: Mangubat
authors.affiliation: Department of Neurosurgery, Rush Professional Office Building, Chicago, Illinois, United States.
authors.forename: Tom
authors.initials: T
authors.lastname: Wilson
authors.affiliation: Department of Neurosurgery, Rush Professional Office Building, Chicago, Illinois, United States.
authors.forename: Brian A
authors.initials: BA
authors.lastname: Mitchell
authors.affiliation: Department of Neurosurgery, Rush Professional Office Building, Chicago, Illinois, United States.
authors.forename: Richard W
authors.initials: RW
authors.lastname: Byrne
keywords: Chiari I malformation; atlanto-occipital assimilation; central sleep apnea; cough syncope; orthopnea
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