Tek Semptomu Özofageal Disfaji Olan Tip I Chiari Malformasyonu Vakası: Tanı ve Tedavi Süreci
Özet
Chiari malformasyonları, serebellar tonsillerin foramen magnumdan aşağıya doğru sarkarak beyin sapına baskı yaptığı nadir bir nörolojik bozukluktur. Tip I Chiari malformasyonu, genellikle baş ağrısı, dengesizlik ve duyusal kayıplar gibi nörolojik belirtilerle kendini gösterir nadiren disfaji gibi semptomlarla da ortaya çıkabilir. Sunduğumuz bu vakada, üç yıl süren özofageal disfaji, göğüs ağrısı ve kilo kaybı şikayetleri sonrası, 27 yaşındaki kadın hastaya Tip I Chiari malformasyonu tanısı konuldu.Başlangıçta gastroenterolojik değerlendirmeler sonuç vermedi, ancak nörolojik muayene ve beyin Manyetik Rezonans Görüntüleme, Chiari malformasyonu ortaya koydu. Videofloroskopi ve özofageal manometri, disfajinin özofagus motilite bozukluğuna bağlı olduğunu gösterdi. Cerrahi dekompresyon sonrası disfaji ve diğer semptomlar tamamen düzeldi. Bu vaka, disfajinin Chiari malformasyonunun tek belirtisi olabileceğini ve tedaviye dirençli disfaji vakalarında nörolojik incelemelerin önemini vurgulamaktadır. Videofluroskopik inceleme, disfaji tanısında kritik rol oynayarak, Chiari malformasyonuna bağlı disfajiyi diğer gastroenterolojik nedenlerden ayırt etmeye yardımcı olmuştur.
Chiari malformations are rare neurological disorders characterized by the downward displacement of the cerebellar tonsils through the foramen magnum, compressing the brainstem. Type I Chiari malformation typically presents with neurological symptoms such as headaches, imbalance, and sensory loss, but it can also, albeit rarely, manifest with gastrointestinal symptoms like dysphagia. In this case, a 27-year-old female patient with a three-year history of progressive esophageal dysphagia, chest pain, and weight loss was diagnosed with Type I Chiari malformation. Initial gastroenterological evaluations were inconclusive, but neurological examination and brain magnetic resonance imaging revealed Chiari malformation. Videofluoroscopy and esophageal manometry confirmed that the dysphagia was caused by esophageal motility disorder. After surgical decompression, the dysphagia and other symptoms completely resolved. This case highlights that dysphagia can be the sole symptom of Chiari malformation and underscores the importance of neurological evaluations in cases of treatment-resistant dysphagia. Videofluoroscopic examination played a critical role in diagnosing dysphagia, distinguishing it from other gastroenterological causes, and identifying the underlying Chiari malformation.
Referanslar
Achiron, A., & Kuritzky, A. (1990). Dysphagia as the sole manifestation of adult type I Arnold-Chiari malformation. Neurology, 10(3), 186-187.
Elta GH, Caldwell CA, Nostrant TT. Esophageal dysphagia as the sole symptom in type I Chiari malformation. Dig Dis Sci. 1996;41(3):512-515. doi:10.1007/BF02282327
Jiménez MD, Friera G, Márquez C, Lozano F. Disfagia como única manifestación de la malformación de Arnold-Chiari del adulto [Dysphagia as the sole manifestation of Arnold-Chiari malformation in adults]. Neurologia. 1991;6(5):188.
Wiles, C. M. (1991). Neurogenic dysphagia. Journal of Neurology, Neurosurgery & Psychiatry, 54(12), 1037-1039.
Pollack, I. F., Pang, D., Kocoshis, S., & Putnam, P. (1992). Neurogenic dysphagia resulting from Chiari malformations. Neurosurgery, 30(5), 709-719.
Almotairi FS, Andersson M, Andersson O, Skoglund T, Tisell M. Swallowing Dysfunction in Adult Patients with Chiari I Malformation. J Neurol Surg B Skull Base. 2018;79(6):606-613. doi:10.1055/s-0038-1655758
Elta GH, Caldwell CA, Nostrant TT. Esophageal dysphagia as the sole symptom in type I Chiari malformation. Dig Dis Sci. 1996;41(3):512-515. doi:10.1007/BF02282327
Jiménez MD, Friera G, Márquez C, Lozano F. Disfagia como única manifestación de la malformación de Arnold-Chiari del adulto [Dysphagia as the sole manifestation of Arnold-Chiari malformation in adults]. Neurologia. 1991;6(5):188.
Referanslar
Achiron, A., & Kuritzky, A. (1990). Dysphagia as the sole manifestation of adult type I Arnold-Chiari malformation. Neurology, 10(3), 186-187.
Elta GH, Caldwell CA, Nostrant TT. Esophageal dysphagia as the sole symptom in type I Chiari malformation. Dig Dis Sci. 1996;41(3):512-515. doi:10.1007/BF02282327
Jiménez MD, Friera G, Márquez C, Lozano F. Disfagia como única manifestación de la malformación de Arnold-Chiari del adulto [Dysphagia as the sole manifestation of Arnold-Chiari malformation in adults]. Neurologia. 1991;6(5):188.
Wiles, C. M. (1991). Neurogenic dysphagia. Journal of Neurology, Neurosurgery & Psychiatry, 54(12), 1037-1039.
Pollack, I. F., Pang, D., Kocoshis, S., & Putnam, P. (1992). Neurogenic dysphagia resulting from Chiari malformations. Neurosurgery, 30(5), 709-719.
Almotairi FS, Andersson M, Andersson O, Skoglund T, Tisell M. Swallowing Dysfunction in Adult Patients with Chiari I Malformation. J Neurol Surg B Skull Base. 2018;79(6):606-613. doi:10.1055/s-0038-1655758
Elta GH, Caldwell CA, Nostrant TT. Esophageal dysphagia as the sole symptom in type I Chiari malformation. Dig Dis Sci. 1996;41(3):512-515. doi:10.1007/BF02282327
Jiménez MD, Friera G, Márquez C, Lozano F. Disfagia como única manifestación de la malformación de Arnold-Chiari del adulto [Dysphagia as the sole manifestation of Arnold-Chiari malformation in adults]. Neurologia. 1991;6(5):188.
