Protracted Respiratory Failure in a Case of Global Spinal Syringomyelia and Chiari Malformation Following Administration of Diazepam: Illustrative Case

Authors

Luke Bauerle
Brandon Rogowski
Aakash Shingala, Thomas Jefferson University HospitalFollow
Habib Emil Rafka
Timothy Webb
Brian F. Saway
Edward F. Kilb
Julio A. Chalela
Nathan C. Rowland

Document Type

Article

Publication Date

11-20-2023

Comments

This article is the author’s final published version in Journal of Neurosurgery: Case Lessons, Volume 6, Issue 21, November 2023, Article number CASE23449.

The published version is available at https://doi.org/10.3171/CASE23449. Copyright © The Authors.

Abstract

BACKGROUND: Syringomyelia is defined as dilation of the spinal cord's central canal and is often precipitated by skull base herniation disorders. Although respiratory failure (RF) can be associated with skull base abnormalities due to brainstem compression, most cases occur in pediatric patients and quickly resolve. The authors report the case of an adult patient with global spinal syringomyelia and Chiari malformation who developed refractory RF after routine administration of diazepam.

OBSERVATIONS: A 31-year-old female presented with malnutrition, a 1-month history of right-sided weakness, and normal respiratory dynamics. After administration of diazepam prior to magnetic resonance imaging (MRI), she suddenly developed hypercapnic RF followed MRI and required intubation. MRI disclosed a Chiari malformation type I and syrinx extending from C1 to the conus medullaris. After decompressive surgery, her respiratory function progressively returned to baseline status, although 22 months after initial benzodiazepine administration, the patient continues to require nocturnal ventilation.

LESSONS: Administration of central nervous system depressants should be closely monitored in patients with extensive syrinx formation given the potential to exacerbate diminished central respiratory drive. Early identification of syrinx in the context of Chiari malformation and hemiplegia should prompt clinical suspicion of underlying respiratory compromise and early involvement of intensive care consultants.

Recommended Citation

Bauerle, Luke; Rogowski, Brandon; Shingala, Aakash; Rafka, Habib Emil; Webb, Timothy; Saway, Brian F.; Kilb, Edward F.; Chalela, Julio A.; and Rowland, Nathan C., "Protracted Respiratory Failure in a Case of Global Spinal Syringomyelia and Chiari Malformation Following Administration of Diazepam: Illustrative Case" (2023). Jefferson Hospital Staff Papers and Presentations. Paper 30.
https://jdc.jefferson.edu/tjuhpapers/30

Creative Commons License

This work is licensed under a Creative Commons Attribution-Noncommercial-No Derivative Works 4.0 License.

Language

English