Skip to main content
SpringerLink
Log in

Relationship of Morphometrics and Symptom Severity in Female Type I Chiari Malformation Patients with Biological Resilience

  • RESEARCH
  • Published:
The Cerebellum Aims and scope Submit manuscript

Abstract

In the present study we report the relationship among MRI-based skull and cervical spine morphometric measures as well as symptom severity (disability—as measured by Oswestry Head and Neck Pain Scale and social isolation—as measured by the UCLA Loneliness scale) on biomarkers of allostatic load using estrogen, interleukin-6, C-reactive protein, and cortisol in a sample of 46 CMI patients. Correlational analyses showed that McRae line length was negatively associated with interleukin-6 and C-reactive protein levels, and Analysis of Variance (ANOVA) showed joint effects of morphometric measures (McRae line length, anterior CSF space) and symptom severity (disability and loneliness) on estrogen and intereukin-6 levels. These results are consistent with allostatic load. That is, when the combination of CSF crowding and self-report symptom (disability and loneliness) severity exceed the capacity of biological resilience factors, then biomarkers such as neuroprotective estrogen levels drop, rather than rise, with increasing symptom severity.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

Data Availability

The dataset is available by request from Philip A. Allen.

References

  1. Milhorat TH, et al. Chiari I malformation redefined: clinical and radiographic findings for 364 symptomatic patients. Neurosurgery. 1999;44(5):1005–17. https://doi.org/10.1097/00006123-199905000-00042.

    Article  CAS  PubMed  Google Scholar 

  2. Houston JR, et al. A morphometric assessment of type I Chiari malformation above the McRae line: A retrospective case-control study in 302 adult female subjects. J Neuroradiol. 2018;45(1):23–31. https://doi.org/10.1016/j.neurad.2017.06.006.

    Article  PubMed  Google Scholar 

  3. Eppelheimer MS, et al. Quantification of changes in brain morphology following posterior fossa decompression surgery in women treated for Chiari malformation type 1. Neuroradiology. 2019;61(9):1011–22. https://doi.org/10.1007/s00234-019-02206-z.

    Article  PubMed  Google Scholar 

  4. Fischbein R, et al. Patient-reported Chiari malformation type I symptoms and diagnostic experiences: a report from the national conquer chiari patient registry database. Neurol Sci. 2015;36(9):1617–24. https://doi.org/10.1007/s10072-015-2219-9.

    Article  PubMed  Google Scholar 

  5. Allen PA, et al. Task-specific and general cognitive effects in Chiari malformation type I. PLoS One. 2014;9(4):e94844. https://doi.org/10.1371/journal.pone.0094844.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  6. Houston JR, et al. Type I Chiari malformation, RBANS performance, and brain morphology: Connecting the dots on cognition and macrolevel brain structure. Neuropsychology. 2019;33(5):725–38. https://doi.org/10.1037/neu0000547.

    Article  PubMed  Google Scholar 

  7. Rogers JM, Savage G, Stoodley MA. A systematic review of cognition in Chiari I malformation. Neuropsychol Rev. 2018;28(2):176–87. https://doi.org/10.1007/s11065-018-9368-6.

    Article  PubMed  Google Scholar 

  8. Garcia M, et al. Comparison between decompressed and non-decompressed Chiari malformation type I patients: a neuropsychological study. Neuropsychologia. 2018;121:135–43. https://doi.org/10.1016/j.neuropsychologia.2018.11.002.

    Article  PubMed  Google Scholar 

  9. Houston ML, Houston JR, Sakaie K, Klinge PM, Vorster S, Luciano MG, Loth F, Allen PA. Functional connectivity abnormalities in Type I Chiari: associations with cognition and pain. Brain Commun. 2021. https://doi.org/10.1093/braincomms/fcab137.

  10. Garcia MA, et al. An examination of pain, disability, and the psychological correlates of Chiari Malformation pre- and post-surgical correction. Disabil Health J. 2019;12(4):649–56. https://doi.org/10.1016/j.dhjo.2019.05.004.

    Article  PubMed  Google Scholar 

  11. Yilmaz A, et al. When is duraplasty required in the surgical treatment of Chiari malformation type I based on tonsillar descending grading scale? World Neurosurg. 2011;75(2):307–13. https://doi.org/10.1016/j.wneu.2010.09.005.

    Article  PubMed  Google Scholar 

  12. Eppelheimer MS, et al. Cerebellar and brainstem displacement measured with DENSE MRI in Chiari malformation following posterior fossa decompression surgery. Radiology. 2021;301(1):187–94. https://doi.org/10.1148/radiol.2021203036.

    Article  PubMed  Google Scholar 

  13. Biswas D, et al. Quantification of cerebellar crowding in type I Chiari malformation. Ann Biomed Eng. 2019;47(3):731–43. https://doi.org/10.1007/s10439-018-02175-z.

    Article  PubMed  Google Scholar 

  14. Cremeans-Smith JK, Boarts JM, Greene K, Delahanty DL. Patients’ reasons for electing to undergo total knee arthroplasty impact post-operative pain severity and range of motion. J Behav Med. 2009;32(3):223–33. https://doi.org/10.1007/s10865-008-9191-2.

    Article  PubMed  Google Scholar 

  15. Garcia MA, Li X, Allen PA, Delahanty DL, Eppelheimer MS, Houston JR, Johnson DM, Loth F, Maleki J, Vorster S, Luciano MG. Impact of surgical status, loneliness, and disability on interleukin 6, C-reactive protein, cortisol, and estrogen in females with symptomatic type I Chiari malformation. Cerebellum. 2021. https://doi.org/10.1007/s12311-021-01251-w.

  16. García M, Eppelheimer MS, Houston JR, Hughes ML, Nwotchouang BST, Kaut KP, Labuda R, Bapuraj JR, Maleki J, Klinge PM, Vorster S, Luciano MG, Loth F, Allen PA. Adult age differences in self-reported pain and anterior CSF space in Chiari malformation. Cerebellum. 2022;21(2):194–207. https://doi.org/10.1007/s12311-021-01289-w.

  17. McEwen BS, Alves SE. Estrogen actions in the central nervous system. Endocr Rev. 1999;20(3):279–307. https://doi.org/10.1210/edrv.20.3.0365.

    Article  CAS  PubMed  Google Scholar 

  18. McEwen BS, Stellar E. Stress and the individual. Mechanisms leading to disease. Arch Intern Med. 1993;153(18):2093–101. [Online]. Available: https://www.ncbi.nlm.nih.gov/pubmed/8379800.

  19. Juster RP, McEwen BS, Lupien SJ. Allostatic load biomarkers of chronic stress and impact on health and cognition. Neurosci Biobehav Rev. 2010;35(1):2–16. https://doi.org/10.1016/j.neubiorev.2009.10.002.

    Article  PubMed  Google Scholar 

  20. Russell D. UCLA loneliness scale (Version 3): reliability, validity, and factor structure. J Pers Assess. 1996;66:20–40.

    Article  CAS  PubMed  Google Scholar 

  21. Fairbanks CT, Couper C, Davies JB, O’Brien JP. The Oswestry low backpain disability questionannaire. Physiotherapy. 1980;66:271–3.

    Google Scholar 

  22. Hoche F, Guell X, Vangel MG, Sherman JC, Schmahmann JD. The cerebellar cognitive affective/Schmahmann syndrome scale. Brain. 2018;141(1):248–70. https://doi.org/10.1093/brain/awx317.

    Article  PubMed  Google Scholar 

  23. Van Overwalle F, Manto M, Leggio M, Delgado-Garcia JM. The sequencing process generated by the cerebellum crucially contributes to social interactions. Med Hypotheses. 2019;128:33–42. https://doi.org/10.1016/j.mehy.2019.05.014.

    Article  PubMed  Google Scholar 

  24. García M, Amayra I, López-Paz JF, Martínez O, Lázaro E, Pérez M, Berrocoso S, Al-Rashaida M, Infante J. Social cognition in Chiari malformation type I: a preliminary characterization. Cerebellum. 2020;19:392–400. https://doi.org/10.1007/s12311-020-01117-7.

    Article  PubMed  Google Scholar 

  25. Allen PA, et al. Chiari 1000 registry project: assessment of surgical outcome on self-focused attention, pain, and delayed recall. Psychol Med. 2018;48(10):1634–43. https://doi.org/10.1017/S0033291717003117.

    Article  CAS  PubMed  Google Scholar 

  26. Lovibond PF, Lovibond SH. The structure of negative emotional states: comparison of the Depression Anxiety Stress Scales (DASS) with the beck depression and anxiety inventories. Behav Res Ther. 1995;33(3):335–43. https://doi.org/10.1016/0005-7967(94)00075-u.

    Article  CAS  PubMed  Google Scholar 

  27. Dworkin RH, et al. Development and initial validation of an expanded and revised version of the Short-form McGill Pain Questionnaire (SF-MPQ-2). Pain. 2009;144(1–2):35–42. https://doi.org/10.1016/j.pain.2009.02.007.

    Article  PubMed  Google Scholar 

  28. Fairbank JCT, Pynsent PB. The oswestry disability index. Spine. 2000;25(22):2940–52. https://doi.org/10.1097/00007632-200011150-00017 (in English).

    Article  CAS  PubMed  Google Scholar 

  29. Vernon H, Mior S. The neck disability index - a study of reliability and validity. J Manip Physiol Ther. 1991;14(7):409–415. [Online]. Available: <Go to ISI>://WOS:A1991GF68000002 (in English).

  30. Keppel G. Design and Analysis: A researcher’s handbook. Englewood Cliffs, N.J.: Prentice-Hall; 1982.

    Google Scholar 

Download references

Funding

This research was funded by NIH NINDS R15 grant 1R15NS109957-01A1 and funding from Conquer Chiari.

Author information

Authors and Affiliations

  1. Department of Bioengineering, Northeastern University, Boston, MA, USA

    Mohamad Motaz Al Samman

  2. Department of Psychological Sciences, Kent State University, Kent, OH, USA

    Monica A. Garcia & Douglas L. Delahanty

  3. Department of Psychology, Faculty of Health Sciences, Neuro-E-Motion Research Team, University of Deusto, Bilbao, Spain

    Maitane García

  4. Department of Psychology, Middle Tennessee State University, Murfreesboro, TN, USA

    James R. Houston

  5. Conquer Chiari Research Center, Northeastern University, Boston, MA, USA

    Dorothy Loth

  6. Conquer Chiari, Wexford, PA, USA

    Richard Labuda

  7. Department of Neurological Surgery, Cleveland Clinic Foundation, Cleveland, OH, USA

    Sarel Vorster

  8. Department of Neurosurgery, Rhode Island Hospital, Warren Alpert Medical School Brown University, Providence, RI, USA

    Petra M. Klinge

  9. Department of Mechanical and Industrial Engineering, Department of Bioengineering, Northeastern University, Boston, MA, USA

    Francis Loth

  10. Department of Psychology, Conquer Chiari Research Center, University of Akron, Akron, OH, USA

    Philip A. Allen

Authors
  1. Mohamad Motaz Al Samman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Monica A. Garcia
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Maitane García
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. James R. Houston
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Dorothy Loth
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Richard Labuda
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Sarel Vorster
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Petra M. Klinge
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Francis Loth
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Douglas L. Delahanty
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Philip A. Allen
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

P.A.A., D.D., Monica G., F.L., and P.K. wrote the main manuscript text, P.A.A. analyzed the data, D.L. completed the morphometric analyses, M.M.A.S. and J.R.H. constructed the Tables and Figures, and S.V. Maitane G., D.L., and R.L. reviewed the manuscript. P.A.A. and M.M.A.S. developed the allostatic load model.

Corresponding author

Correspondence to Philip A. Allen.

Ethics declarations

Ethical Approval

This research was approved by the University of Akron Institutional Review Board. All participants provided informed consent.

Competing Interests

We have no competing interests with regard to this research.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Al Samman, M.M., Garcia, M.A., García, M. et al. Relationship of Morphometrics and Symptom Severity in Female Type I Chiari Malformation Patients with Biological Resilience. Cerebellum (2023). https://doi.org/10.1007/s12311-023-01627-0

Download citation

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1007/s12311-023-01627-0

Keywords

Search

Navigation