{"id":"ff820f72-7aa3-4311-8f49-db9cdd233c94","slug":"sudden-unexpected-nocturnal-death-in-chiari-type-1-malformation-and-potential-role-of-opioid-analgesics-3","title":"Sudden unexpected nocturnal death in Chiari type 1 malformation and potential role of opioid analgesics","authors":["Fereydoon Roohi","Toby Gropen"],"abstract":"Background: Chiari type 1 malformation (CM1) is associated with various complications, including sleep apnea and hydrocephalus. The potential role of opioid analgesics in exacerbating intracranial pressure (ICP) and contributing to sudden unexpected nocturnal death in patients with CM1 has been highlighted. Previous literature suggests that bolus dosing of opioids may increase ICP, particularly in patients with compromised intracranial compliance. Methods: The article discusses a case where brain imaging and postmortem examinations were conducted to evaluate the condition of a patient with CM1 who experienced sudden death. The imaging studies aimed to exclude the presence of a trapped fourth ventricle and assess the state of the cerebrospinal fluid pathways. Results: Findings indicated that the patient had a disproportionately large communicating fourth ventricle and evidence of hydrocephalus, but no trapped fourth ventricle was identified. The patient’s clinical history included chronic opioid use, which may have contributed to elevated ICP and subsequent cardiorespiratory arrest during sleep. Conclusion: The authors emphasize the need for awareness among clinicians regarding the risks associated with opioid use in patients with CM1, particularly concerning the potential for increased ICP and subsequent fatal outcomes. They advocate for cautious management of opioid analgesics in such patients to prevent exacerbation of their condition. Keywords: Chiari malformation, opioid analgesics, intracranial pressure, sudden death, sleep apnea, hydrocephalus","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/ff820f72-7aa3-4311-8f49-db9cdd233c94/featured/hero-1782421002048.png","publishDate":"2014-12-11T00:00:00.000Z","doi":"10.4103/2152-7806.146817","categories":["Original Article"],"fullTextUrl":"https://surgicalneurologyint.com/wp-content/uploads/2015/05/3941/SNI-5-177.pdf"}