Although his right hand had been weak for many years, he thought it was congenital and did not affect his daily activities much, so Mr. M. did not go to the doctor. In the past 3 years, he began to notice a gradual decrease in muscle strength and muscle atrophy. At first, he only had a weak grip and got tired quickly when writing, then he could not lift heavy objects, especially the 3 fingers of his right hand were curled up and difficult to straighten. Recently, his right hand has been shaking more and more, he could not hold the steering wheel when riding a motorbike, so he decided to go to Tam Anh General Hospital in Ho Chi Minh City for a check-up.
The surgeon decompressed and prevented the progression of spinal stenosis for Mr. M.
Photo: BVCC
The risk of irreversible pulp damage is very high.
Master - Specialist Doctor 2 Dang Bao Ngoc, Department of Neurosurgery - Spine, Tam Anh General Hospital, Ho Chi Minh City, said that the 3 Tesla MRI results showed that Mr. M. had abnormalities in the posterior cranial fossa and spinal cord, diagnosed with Arnold Chiari syndrome type 1. This is a rare congenital neurological defect, formed in the fetal stage, characterized by a part of the cerebellum descending through the foramen magnum - the connection between the base of the skull and the spinal cord, causing compression and obstruction of the flow of cerebrospinal fluid, resulting in the formation of a hollow spinal canal, also known as syringomyelia.
Dr. Bao Ngoc said that when the cerebellum and spinal cord are compressed for a long time, the patient may experience numbness and weakness in the limbs, loss of balance, and even permanent paralysis. “In Mr. M.'s case, clinical symptoms of spinal canal emptiness have appeared, meaning the disease has progressed severely. Although the patient tries to walk on his own, if it is delayed any longer, the risk of irreversible spinal cord damage is very high,” Dr. Ngoc said.
Discharged from hospital 5 days after surgery
After consultation, the doctors decided to perform posterior cranial fossa decompression surgery on Mr. M., with the aim of creating more space for cerebellum and medulla oblongata, restoring cerebrospinal fluid circulation, thereby improving symptoms and preventing progression of syringomyelia.
At the beginning of the surgery, the doctor made an incision of about 8 cm in the nape of the neck, removed part of the occipital bone and the posterior arch of the C1 cervical vertebra to create more space for the cerebellum to fall down, releasing the medulla oblongata. Under the AI K.Zeiss Kinevo 900 microscope, which magnifies the image many times, the doctor clearly observed each blood vessel, nerve, and meningeal membrane, thereby making the operation more precise and safe.
After opening the dura mater - the membrane surrounding the brain and spinal cord, the team proceeded to cut away the thick, fibrotic arachnoid membrane, re-establish cerebrospinal fluid circulation, and patch the dura mater with autologous fascia, creating more space for cerebrospinal fluid to circulate, reducing the risk of re-compression. Finally, the incision was sutured in multiple layers to prevent the risk of cerebrospinal fluid leakage, while ensuring the wound was securely closed. The entire surgery lasted about 3 hours.
After just one day, Mr. M. was awake, no longer had a headache and no longer felt heavy in the neck, and his limbs moved significantly better. On the second day after surgery, Mr. M. was able to stand up and walk normally and was discharged from the hospital 5 days after surgery.
The doctor checked Mr. M's wound after surgery.
Photo: BVCC
Arnold Chiari malformation type 1 occurs in approximately 0.5-3.5% of the population
According to Dr. Ngoc, symptoms of dizziness, nausea or headache will gradually decrease and usually go away after 2-3 weeks. In the case of syringomyelia, it takes about 6 months to a year for the fluid pockets to gradually shrink and the nerves to recover. Patients need to be monitored periodically with MRI to evaluate the results and prevent recurrence.
Arnold Chiari malformation type 1 occurs in approximately 0.5-3.5% of the general population, with a male-to-female ratio of 1:1.3. Most early cases are asymptomatic and are often discovered incidentally through magnetic resonance imaging (MRI). The syndrome can occur at any age, but is often discovered in young people, especially in adulthood, when symptoms become more obvious. The most common symptoms are occipital headaches, which are especially worse when coughing, sneezing, bending over, accompanied by dizziness, unsteady gait, loss of balance, numbness and weakness of the limbs, even difficulty swallowing or speech disorders.
Doctor Ngoc recommends that when there are prolonged abnormal signs, especially persistent occipital headaches, numbness in limbs or difficulty controlling movements, patients should go to the doctor. hospital have neurology specialists to examine and perform necessary tests and imaging for accurate diagnosis and optimal treatment regimen.
Source: https://thanhnien.vn/chang-trai-mac-benh-hiem-gap-khien-nao-tut-xuong-co-185251018182751669.htm
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