///2010 Abstract Details
2010 Abstract Details2018-05-01T17:52:49+00:00

ARNOLD CHIARI TYPE I MALFORMATION IN PARTURIENT WITH CO-EXISTING COMPLETE CONGENITAL HEART BLOCK

Abstract Number: 222
Abstract Type: Case Report/Case Series

Jennifer Elmore D.O.1 ; Mona Halim-Armanios MD2

ARNOLD CHIARI TYPE I MALFORMATION IN PARTURIENT WITH CO-EXISTING COMPLETE CONGENITAL HEART BLOCK

Jennifer Elmore, D.O., Mona Halim-Armanio, MD.

Ohio State University, Columbus, Ohio

Introduction: Arnold chiari type I malformation is an uncommon neurologic anomaly where there is herniation of the cerebellar tonsils through the foramen magnum. In a parturient this condition can pose difficulty in anesthetic management for labor and delivery. In addition to having the Arnold chiari malformation, this parturient also had a complete congenital heart block

Case Presentation: A 26 year old primigravida with a known Arnold chiari type I malformation and complete congenital heart block presented for induction of labor. The patient had a posterior fossa decompression and a VP shunt placement at age 12 for her symptoms from arnold chiari I. She had a permanent pacemaker placed as a child. She was 39+1 weeks gestation. A prior anesthesia consultation was done and recommendation made for neurology and cardiology consults to be obtained. The initial plan to deliver vaginally was changed to cesarean delivery after discussion among the healthcare providers. A general anesthetic technique was employed for her cesarean delivery.

Discussion: The anesthetic considerations for this patient were extensive. Deciding which anesthetic technique to employ brought up concern for the safety of regional techniques and assessing the risks and benefits of general anesthesia. Many say that spinal anesthesia should be avoided due to the risk of intracranial fluid shifting and possibility of causing further herniation to occur. There are case reports of neuraxial techniques without neurologic sequelae. In our case the patient reported headaches and left sided upper extremity weakness leading more toward our final decision of general anesthesia. The additional complete congenital heart block in our patients medical history made her case more complex.

References: 1. Rastogi, S, et al. (2005) Annals of cardiac anaesthesia 8: 21-32. 2. Chantigian, R, et al. (2002) Journal of clinical anesthesia 14: 201-205. 3. Parker, J, et al. (2002) American Journal of Perinatology 19: 445-449.

SOAP 2010