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. 2015 Oct-Dec;10(4):321-5.
doi: 10.4103/1817-1745.174443.

The relationship between obesity and symptomatic Chiari I malformation in the pediatric population

Sandi Lam  1 , Brenda Auffinger  1 , Matthew Tormenti  2 , Christopher Bonfield  2 , Stephanie Greene  2
Affiliations

The relationship between obesity and symptomatic Chiari I malformation in the pediatric population

Sandi Lam et al. J Pediatr Neurosci. 2015 Oct-Dec.

Abstract

Background: Concomitant with the rise in childhood obesity in the United States is an increase in the diagnosis of Chiari I malformation (CM1).

Objective: To discern a correlation between obesity and CM1, defined as >5 mm of cerebellar tonsillar descent on sagittal magnetic resonance imaging.

Methods: Charts of CM1 patients aged 2-20 years were retrospectively reviewed. Chiari size, age, body mass index (BMI), and CM1 signs/symptoms were recorded. Patients were stratified by age: 2-9, 10-14, and 15-20 years. Mixed-effect linear models and linear regression analysis were applied to investigate the relationship between BMI-for-age percentiles and CM1 signs/symptoms.

Results: One hundred sixty-seven patients were included (mean age 14.5 ± 2.97 years, BMI 22.98 ± 6.5, and Chiari size 12.27 mm ± 5.91). When adjusted for age, 42% were overweight or obese-higher than normative BMI for children in the studied area (29.6%). When stratified by age, patients between 2 and 9 years were most commonly obese and presented the highest mean BMI (25.66), largest Chiari size (13.58), and highest incidence of headache (75%) and syringomyelia (66.67%). Patients between 15 and 20 years were most commonly overweight and presented the smallest Chiari size (11.76 mm), but the highest incidence of cerebellar (50%) and brainstem (8.55%) compression symptoms. A significant positive correlation existed between BMI and headache in the first two age groups: (R (2): 0.36, P = 0.03; R (2): 0.39, P = 0.01, respectively). Obese patients had higher incidence of headache in the 10-14 group (R (2): 0.37, P = 0.02) and the largest Chiari size in the 15-20 group (R (2): 0.40, P = 0.03).

Conclusions: The pediatric CM1 population is more likely to be overweight or obese. Younger obese patients presented the highest incidence of Chiari-related headache symptoms, and older obese patients, the highest incidence of findings other than headache. Thus, body weight and age should be considered when evaluating children with CM1.

Keywords: Body mass index; Chiari 1 malformation; idiopathic intracranial hypertension; obesity; pediatric; pseudotumor cerebri; tonsillar descent.

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References

    1. Aboulezz AO, Sartor K, Geyer CA, Gado MH. Position of cerebellar tonsils in the normal population and in patients with Chiari malformation: A quantitative approach with MR imaging. J Comput Assist Tomogr. 1985;9:1033–6. - PubMed
    1. Barkovich AJ, Wippold FJ, Sherman JL, Citrin CM. Significance of cerebellar tonsillar position on MR. AJNR Am J Neuroradiol. 1986;7:795–9. - PMC - PubMed
    1. Elster AD, Chen MY. Chiari I malformations: Clinical and radiologic reappraisal. Radiology. 1992;183:347–53. - PubMed
    1. Milhorat TH, Chou MW, Trinidad EM, Kula RW, Mandell M, Wolpert C, et al. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 1999;44:1005–17. - PubMed
    1. Bejjani GK. Association of the Adult Chiari Malformation and Idiopathic Intracranial Hypertension: More than a coincidence. Med Hypotheses. 2003;60:859–63. - PubMed