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Previous issue date: 2016-03-11 === INTRODUÇÃO: A cefaleia faz parte do cotidiano do ser humano desde a pré-história e lhe
era atribuído um caráter sobrenatural. Na população brasileira a prevalência de cefaleia é
elevada, porém apresenta etiologias diferentes e tratamentos distintos, sendo necessário um
maior conhecimento a seu respeito. É subdividida em três grupos: cefaleias primárias,
secundárias e neuropatias cranianas dolorosas, outras dores faciais e outras cefaleias. Dentre os
possíveis desencadeadores da crise de cefaleia há a má-formação de Chiari (MFC) que se
apresenta como resultado de um menor volume craniano (fossa posterior) e herniação das
tonsilas cerebelares para dentro do forame magno, causando um efeito semelhante a uma rolha
e, por conseguinte, obstruindo o fluxo de LCR (líquido cefalorraquidiano) e aumentando a
pressão intracraniana. O diagnóstico rápido dessa má-formação colabora no reestabelecimento
da qualidade de vida do paciente. OBJETIVOS: Identificar e comparar características
morfológicas da fossa posterior, transiç
grupo com cefaleia apresentaram valores de herniação tonsilar menores que o grupo sem
cefaleia (p=0,05). Além desse fato, percebeu-se que o lado esquerdo em ambos os subgrupos
apresenta valores maiores que o lado direito. Embora na comparação entre as mulheres (grupos
com e sem cefaleia de esforço) a herniação não tenha sido estatisticamente significativa (direita
= 0,81 / esquerda = 0,14), o lado esquerdo também apresentou comportamento semelhante ao
identificado nos homens. CONCLUSÃO: Há, de fato, outras diferenças morfológicas entre
pacientes com MFCI e indivíduos saudáveis além das atualmente utilizadas como critério
diagnóstico para a doença. Nas mulheres algumas variáveis apresentaram valores maiores que
nos homens, sugerindo que há ocupação de um maior espaço dentro do volume craniano total.
Embora não tenha sido o objetivo deste trabalho, identificou-se que tanto nos homens quanto
nas mulheres com MFCI, o lado esquerdo apresentava valores maiores que o lado direito em
grande parte das medidas, sugerindo que talvez seja possível avaliar prioritariamente o lado
esquerdo, possibilitando assim um tratamento mais rápido e com menores riscos ao paciente. A
herniação da tonsila esquerda, juntamente com a altura do cerebelo e a área do tronco cerebral
dentro do forame magno também apresentaram evidência clínica. === INTRODUCTION: Headache is part of human daily life since prehistory and her supernatural
character was assigned. In the Brazilian population the prevalence of headache is high, but has
different etiologies and different treatments, requiring greater knowledge about them. It is
divided into three groups: primary headache disorders, cranial neuropathies secondary and
painful, other facial pain and other headaches. Among the possible triggers of headache crisis
there is a malformation of Chiari (MFC) that appears as a result of lower cranial volume
(posterior fossa) and herniation of the cerebellar tonsils into the foramen magnum, causing a
similar effect to a stopper and therefore obstructing the flow of CSF (cerebrospinal fluid) and
increased intracranial pressure. The rapid diagnosis of this malformation collaborates in the
reestablishment of the patient's quality of life. OBJECTIVES: To identify and compare
morphological characteristics of the posterior fossa, craniocervical transition, brainstem,
cerebellum, herniation of the cerebellar tonsils in patients with malformation of Chiari I (MFCI)
and headache versus a control group. METHODS: Analytical studies, case-control to assess
whether there are features and morphological differences between patients with or without
headache MFCI with effort and people without this malformation. Patients of both sexes, aged
between 20 and 59 years were invited to participate in the study and those who accepted were
classified into three groups (MFCI with headache, MFCI without headache and control group).
All groups underwent MRI without contrast head. those who had other neurological diseases,
neurological clips and refusal to sign the consent form were excluded of this research.
Volumetric data, area and length of the structures involved in MFCI were obtained. The normal
distribution was analyzed, and subsequently data were statistically tested. RESULTS: The age
difference between the study group and the control group was not statistically significant (43.01
± 7.44 and 38.86 ± 9.34, p> 0.05, respectively). Comparing patients with Chiari and control
group, it was found that measures such as the area of the foramen magnum, cerebellar volume,
brainstem volume, herniated tonsils (both sides), diameter of the foramen magnum (both
anteroposterior as latero side) have equivalent importance for the diagnosis of this malformation
(p <0.001). The height of the cerebellum and the brain stem area within the foramen magnum
also statistically significant (p <0.01). These findings add to the depth variables of the posteriorfossa volume of the posterior fossa and length of tonsillar herniation, both identified statistical
significance also in this study (p <0.001), and which are used as the MFCI diagnostic criteria.
In the intragroup comparison (with effort headache or without effort headache), the men in the
group with headache had lower tonsillar herniation values than the group without headache (p
= 0.05). In addition to this fact, it was noticed that the left side in both subgroups shows higher
values than the right side. Although the comparison between women (groups with and without
headache effort) herniation was not statistically significant (= 0.81 right / left = 0.14), the left
side also showed similar behavior identified in men. CONCLUSION: There is, in fact, other
morphological differences between patients and healthy individuals MFCI beyond the currently
used as a diagnostic criterion for the disease. In women some variables showed higher values
than in men, suggesting that there is occupying a larger space within the total cranial volume.
Although it was not the purpose of this study, it was found that both men and women with
MFCI, the left side had values greater than the right side in most of the measures, suggesting
that it may be possible primarily evaluate the left, allowing so a faster treatment and less risk
to the patient. The herniation of the left tonsil, together with the height of the cerebellum and
the brain stem area within the foramen magnum also showed clinical evidence.
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