Chiari I malformation with neurogenic hypertension underwent suboccipital decompression: A case report

Abstract Chiari malformations have a wide array of clinical symptoms related to compression of the craniocervical structure. An uncommon symptom is neurogenic hypertension, which remains controversial from its origin, its clinical clues that suggest the diagnosis, and the intervention best suited fo...

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Main Authors: Steven Okta Chandra, I Putu Pramana Suarjaya, Ida Bagus Krisna Jaya Sutawan, Tjokorda Gde Agung Senapathi, Tjokorda Gde Bagus Mahadewa
Format: Article
Language:English
Published: Wolters Kluwer Medknow Publications 2024-04-01
Series:Bali Journal of Anesthesiology
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Online Access:https://doi.org/10.4103/bjoa.bjoa_32_24
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author Steven Okta Chandra
I Putu Pramana Suarjaya
Ida Bagus Krisna Jaya Sutawan
Tjokorda Gde Agung Senapathi
Tjokorda Gde Bagus Mahadewa
author_facet Steven Okta Chandra
I Putu Pramana Suarjaya
Ida Bagus Krisna Jaya Sutawan
Tjokorda Gde Agung Senapathi
Tjokorda Gde Bagus Mahadewa
author_sort Steven Okta Chandra
collection DOAJ
description Abstract Chiari malformations have a wide array of clinical symptoms related to compression of the craniocervical structure. An uncommon symptom is neurogenic hypertension, which remains controversial from its origin, its clinical clues that suggest the diagnosis, and the intervention best suited for its treatment. Several case reports suggest this disorder will resolve after suboccipital decompression reflecting compressive effect in its nature. An important structure thought to be involved in this disorder is the ventrolateral medulla. This structure has an important role in blood pressure control and has been studied extensively. We present a case of a 24-year-old woman diagnosed with Chiari I malformation experiencing hypertensive urgency intraoperatively when the surgeon decompressed the suboccipital structure. The finding was anticipated based on history taking which revealed the patient experienced the same condition with additional ventricular tachyarrhythmia prior incision of suboccipital skin. The case was canceled and the patient was stabilized in the intensive care unit before being referred to our hospital. Hypertension in the intraoperative period can cause morbidity and mortality. This condition requires immediate treatment once it is noticed. Multidisciplinary approach and diagnostic study preoperatively have an important role as a supplement for anesthesiologists in making a clinical decision intraoperatively for the sake of preventing morbidity and mortality.
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institution Kabale University
issn 2549-2276
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publisher Wolters Kluwer Medknow Publications
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series Bali Journal of Anesthesiology
spelling doaj-art-5ae17dd33af74fc7b9c9be9125b640bb2025-01-25T09:57:50ZengWolters Kluwer Medknow PublicationsBali Journal of Anesthesiology2549-22762024-04-018212312610.4103/bjoa.bjoa_32_24Chiari I malformation with neurogenic hypertension underwent suboccipital decompression: A case reportSteven Okta ChandraI Putu Pramana SuarjayaIda Bagus Krisna Jaya SutawanTjokorda Gde Agung SenapathiTjokorda Gde Bagus MahadewaAbstract Chiari malformations have a wide array of clinical symptoms related to compression of the craniocervical structure. An uncommon symptom is neurogenic hypertension, which remains controversial from its origin, its clinical clues that suggest the diagnosis, and the intervention best suited for its treatment. Several case reports suggest this disorder will resolve after suboccipital decompression reflecting compressive effect in its nature. An important structure thought to be involved in this disorder is the ventrolateral medulla. This structure has an important role in blood pressure control and has been studied extensively. We present a case of a 24-year-old woman diagnosed with Chiari I malformation experiencing hypertensive urgency intraoperatively when the surgeon decompressed the suboccipital structure. The finding was anticipated based on history taking which revealed the patient experienced the same condition with additional ventricular tachyarrhythmia prior incision of suboccipital skin. The case was canceled and the patient was stabilized in the intensive care unit before being referred to our hospital. Hypertension in the intraoperative period can cause morbidity and mortality. This condition requires immediate treatment once it is noticed. Multidisciplinary approach and diagnostic study preoperatively have an important role as a supplement for anesthesiologists in making a clinical decision intraoperatively for the sake of preventing morbidity and mortality.https://doi.org/10.4103/bjoa.bjoa_32_24case reportchiari malformationneurogenic hypertensionsuboccipital decompressionventrolateral medulla
spellingShingle Steven Okta Chandra
I Putu Pramana Suarjaya
Ida Bagus Krisna Jaya Sutawan
Tjokorda Gde Agung Senapathi
Tjokorda Gde Bagus Mahadewa
Chiari I malformation with neurogenic hypertension underwent suboccipital decompression: A case report
Bali Journal of Anesthesiology
case report
chiari malformation
neurogenic hypertension
suboccipital decompression
ventrolateral medulla
title Chiari I malformation with neurogenic hypertension underwent suboccipital decompression: A case report
title_full Chiari I malformation with neurogenic hypertension underwent suboccipital decompression: A case report
title_fullStr Chiari I malformation with neurogenic hypertension underwent suboccipital decompression: A case report
title_full_unstemmed Chiari I malformation with neurogenic hypertension underwent suboccipital decompression: A case report
title_short Chiari I malformation with neurogenic hypertension underwent suboccipital decompression: A case report
title_sort chiari i malformation with neurogenic hypertension underwent suboccipital decompression a case report
topic case report
chiari malformation
neurogenic hypertension
suboccipital decompression
ventrolateral medulla
url https://doi.org/10.4103/bjoa.bjoa_32_24
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AT idabaguskrisnajayasutawan chiariimalformationwithneurogenichypertensionunderwentsuboccipitaldecompressionacasereport
AT tjokordagdeagungsenapathi chiariimalformationwithneurogenichypertensionunderwentsuboccipitaldecompressionacasereport
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