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A type I Chiari malformation consists of abnormal extension of the cerebellar tonsils 3 to 5 mm below the foramen magnum. The most common symptom of a Chiari I malformation (CMI) in adults is suboccipital headache exacerbated by Valsalva maneuvers. Additional findings include vertigo, ataxia, lower cranial neuropathies, spastic tetraparesis, and syringomyelic sensory loss.1 Central sleep apnea is rarely attributed to CMI in adults, although breathing dysrhythmias are well recognized in children.2 In a recent study, 140 of 364 (38%) patients with CMI had signs and symptoms of sleep apnea: 30 were confirmed by polysomnography.1 We report a 72-year-old woman with a CMI and severe central sleep apnea leading to respiratory failure (Ondine’s curse) who improved after suboccipital decompression and duraplasty.
Case report.
A 72-year-old woman with hypertension developed dysphagia, diplopia, and an unsteady gait 3 weeks before admission. On the day of admission, she was brought to the hospital by her family after being found unarousable from sleep. Initial examination was remarkable for coma with absent gag …
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