cerebellar tonsillar hernia
Introduction
Introduction to cerebellar tonsil The cerebellar tonsil malformation is also known as Arnold-Chiari malformation and Arnold-Chiari syndrome, which is a congenital dysplasia of the hindbrain. It is a congenital hindbrain malformation that causes abnormal embryonic development to invade the spinal canal in the lower medulla and fourth ventricle. The cerebellar tonsil is extended into a wedge shape and enters the occipital foramen or cervical spinal canal. In severe cases, part of the lower iliac crest is also inserted into the spinal canal. The posterior group of the pharyngeal, vagus, accessory, sublingual and other groups are pulled down and down. The occipital foramen and the upper cervical canal are filled, and cerebrospinal fluid circulation is blocked to cause hydrocephalus. At present, the opinions on the pathogenesis of this disease are different. It is believed that the squat is the excessive growth and extension of the brain tissue in the midline of the cranial fossa after the embryonic period. After the addition, the volume of the cranial fossa is reduced, which makes it lower through the occipital foramen. Into the cervical spinal canal, and some even down to the axis or lower, and even severely damage the cerebellum, brain stem and high cervical spinal cord, cervical nerves, etc., and can cause hydrocephalus, the disease often combined with other occipital deformities, such as the skull base Depression, sacral pillow fusion, flat skull base, cervical vertebra segmentation and so on. basic knowledge The proportion of illness: 0.03 Susceptible people: no specific population Mode of infection: non-infectious Complications: skull base depression hydrocephalus
Cause
Cerebellar tonsil sputum
Cause (60%):
At present, the opinions on the pathogenesis of this disease are different. It is believed that the squat is the excessive growth and extension of the brain tissue in the midline of the cranial fossa after the embryonic period. After the addition, the volume of the cranial fossa is reduced, which makes it lower through the occipital foramen. Into the cervical spinal canal, and some even down to the axis or lower, and even severely damage the cerebellum, brain stem and high cervical spinal cord, cervical nerves, etc., and can cause hydrocephalus, the disease often combined with other occipital deformities, such as the skull base Depression, sacral pillow fusion, flat skull base, cervical vertebra segmentation and so on.
Prevention
Cerebellar tonsil sputum prevention
There are no special precautions for this disease. Pay attention to medication safety:
1. Appropriate neurotrophic therapy after surgery may promote the recovery of neurological function to a certain extent, but the use of drugs alone can not curb the increase of nerve damage.
2. Symptomatic treatment usually can relieve pain and anti-dizziness, improve symptoms and improve quality of life, and has no effect on relieving nerve damage.
3. Appropriate medical treatment is beneficial for those who do not need surgery, who have surgical contraindications or who are unwilling to undergo surgery.
Complication
Cerebellar tonsil complication Complications, skull base depression, hydrocephalus
1. This disease often combined with other large occipital deformities, such as skull base depression, sacral pillow fusion, flat skull base, cervical vertebra segmentation and so on.
2. Intraoperative complications.
Symptom
Cerebellar tonsil squat symptoms Common symptoms Drunken gait ataxia intracranial pressure increased hydrocephalus sensation separation sensory disturbance hoarseness dysphagia eye tremor
Mild cerebellar tonsils can be asymptomatic, traumatic, infection, cough and lumbar puncture can induce symptoms or aggravate symptoms. The symptoms caused by cerebellar tonsillar sputum generally have the following aspects:
1. Cranial nerve and cervical nerve symptoms: manifested as hoarseness, difficulty swallowing, neck pain and limited mobility.
2. Brain stem medullary symptoms: There may be limb dyskinesia, hemiplegia and quadriplegia, sensory disturbance of the limbs, and dysfunction of the stool.
3. Cerebellar symptoms: Ataxia, unstable walking and nystagmus can occur.
4. Increased intracranial pressure symptoms: hydrocephalus can occur such as headache, vomiting, fundus edema and decreased vision.
5. Spontaneous stenosis: accompanied by syringomyma may occur in sensory separation or double upper limb muscle atrophy.
Examine
Cerebellar tonsil sputum examination
To confirm the diagnosis and differential diagnosis, MRI is also magnetic resonance imaging. It is a kind of tomographic imaging that uses electromagnetic resonance to obtain electromagnetic signals from the human body and reconstruct human body information. Can clearly show the specific part of the cerebellar tonsil sacral, with or without medullary and fourth ventricle, cerebral palsy, with or without syringomyelia and hydrocephalus, X-ray examination and CT can understand the cranial neck Bone deformity.
Diagnosis
Diagnosis and differentiation of cerebellar tonsillar chin
The disease should be differentiated from the intracranial space-occupying lesions of the cerebellar tonsil occipital foramen: the former tonsils are mostly tongue-shaped and often combined with other malformations; while the latter tonsils are mostly conical and can simultaneously display intracranial space-occupying lesions. The signs are not difficult to identify. Diagnosis: According to the age of onset, clinical manifestations and auxiliary examination, the diagnosis of cerebellar tonsillar sacral malformation is generally not difficult. MRI examination of head and neck, especially the sagittal image can clearly show the degree of cerebellar tonsil squat, as well as secondary hydrocephalus and spinal cord. Cavity, etc., is an important basis for diagnosis.
1. Cranial vertebrae: The skull and cranial vertebrae can show their combined bone deformities, such as basal sag, sacral fusion, spina bifida, Klippel-Feil syndrome.
2. CT scan: CT scan mainly shows various pathological changes through spinal canal and cerebral angiography combined with coronary scanning and sagittal reconstruction techniques.
