Coronavirus disease 2019-associated persistent cough and Chiari malformation type I resulting in acute respiratory failure: illustrative case

Anthony J Piscopo; Nahom Teferi; Anthony Marincovich; Meron Challa; Brian J Dlouhy

doi:10.3171/CASE23555

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Coronavirus disease 2019-associated persistent cough and Chiari malformation type I resulting in acute respiratory failure: illustrative case

Journal article

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Coronavirus disease 2019-associated persistent cough and Chiari malformation type I resulting in acute respiratory failure: illustrative case

Anthony J Piscopo, Nahom Teferi, Anthony Marincovich, Meron Challa and Brian J Dlouhy

Journal of neurosurgery. Case lessons, Vol.6(25), CASE23555

12/18/2023

DOI: 10.3171/CASE23555

PMCID: PMC10732323

PMID: 38109716

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Abstract

Chiari malformation type I (CM-I) is the herniation of cerebellar tonsils through the foramen magnum, potentially resulting in the obstruction of cerebrospinal fluid flow and brainstem compression. Sleep-disordered breathing (SDB) is common in patients with CM-I, and symptomatic exacerbations have been described after Valsalva-inducing stressors. Acute decompensation in the setting of coronavirus disease 2019 (COVID-19) has not been described. After violent coughing episodes associated with COVID-19 infection, a 44-year-old female developed several months of Valsalva-induced occipital headaches, episodic bulbar symptoms, and worsening SDB, which led to acute respiratory failure requiring mechanical ventilation. Imaging demonstrated 12 mm of cerebellar tonsillar descent below the foramen magnum, dorsal brainstem compression, and syringobulbia within the dorsal medulla. She underwent posterior fossa and intradural decompression with near-complete resolution of her symptoms 6 months postoperatively. Although CM-I can remain asymptomatic, Valsalva-inducing stressors, including COVID-19 infection, can initiate or acutely exacerbate symptoms, placing patients at risk for CM-I-associated brainstem dysfunction and, in rare cases, acute respiratory failure. Worsening Valsalva maneuvers can contribute to further cerebellar tonsil impaction, brainstem compression, syringomyelia/syringobulbia, and worsening CM-I intradural pathology. Ventilator support and timely decompressive surgery are paramount, as brainstem compression can reduce central respiratory drive, placing patients at risk for coma, neurological deficits, and/or death.

COVID-19

sleep-disordered breathing

Chiari malformation type I

syringobulbia

Details

Title: Subtitle: Coronavirus disease 2019-associated persistent cough and Chiari malformation type I resulting in acute respiratory failure: illustrative case
Creators: Anthony J Piscopo - University of Iowa
Nahom Teferi - University of Iowa Hospitals and Clinics
Anthony Marincovich - University of Iowa
Meron Challa - University of Iowa
Brian J Dlouhy - University of Iowa
Resource Type: Journal article
Publication Details: Journal of neurosurgery. Case lessons, Vol.6(25), CASE23555
DOI: 10.3171/CASE23555
PMID: 38109716
PMCID: PMC10732323
NLM abbreviation: J Neurosurg Case Lessons
eISSN: 2694-1902
Language: English
Date published: 12/18/2023
Academic Unit: Stead Family Department of Pediatrics; Iowa Neuroscience Institute; Neurosurgery
Record Identifier: 9984532055402771

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