Entrainment and multi-stability of the p53 oscillator in human cells.

The tumor suppressor p53 responds to cellular stress and activates transcription programs critical for regulating cell fate. DNA damage triggers oscillations in p53 levels with a robust period. Guided by the theory of synchronization and entrainment, we developed a mathematical model and experimental system to test the ability of the p53 oscillator to entrain to external drug pulses of various periods and strengths. We found that the p53 oscillator can be locked and entrained to a wide range of entrainment modes. External periods far from p53's natural oscillations increased the heterogeneity between individual cells whereas stronger inputs reduced it. Single-cell measurements allowed deriving the phase response curves (PRCs) and multiple Arnold tongues of p53. In addition, multi-stability and non-linear behaviors were mathematically predicted and experimentally detected, including mode hopping, period doubling, and chaos. Our work revealed critical dynamical properties of the p53 oscillator and provided insights into understanding and controlling it. A record of this paper's transparent peer review process is included in the supplemental information.

The Benefits of Cognitive Therapeutic Exercise in Symptomatic Arnold-Chiari Syndrome Type I: A Case Report on Gait, Balance, and Pain Management.

BACKGROUND: Chiari malformation is a rare congenital condition in which the cerebellar tonsils herniate through the foramen magnum, causing symptoms related to compression of the surrounding structures. Rehabilitation plays a key role in the pre- and post-operative management of the syndrome, as it can improve strength, range of motion, motor coordination, pain management, and performance of activities of daily living. METHODS: This article presents the case of a 43-year-old woman with Chiari malformation 1B who underwent resection of the filum terminale. She presented as an outpatient at the University Hospital "G. Martino" in Messina, complaining of difficulty walking, balance problems, lumbar pain, and heaviness in the lower limbs. Following a multidisciplinary assessment, she underwent an 11-month rehabilitation protocol based on cognitive therapeutic exercise. RESULTS: The patient achieved significant improvements in pain, mental confusion, and quality of life after treatment and at the 12-month follow-up. CONCLUSIONS: The results of this study highlight the significant benefits of cognitive therapeutic exercises in Chiari malformation, with improvements in several key areas, including quality of life, pain management, and ability to perform activities of daily living.

Intraoperative neuromonitoring in Chiari I malformation surgery: a systematic review and meta-analysis.

Chiari Malformation Type I (CMI) is a prevalent neurosurgical condition characterized by the descent of cerebellar tonsils below the foramen magnum. Surgery, aimed at reducing symptomatology and syrinx size, presents risks, making intraoperative neuromonitoring (IONM) a potentially vital tool. Despite its widespread use in cervical spine surgery, the utility of IONM in CMI surgery remains controversial, with concerns over increased operative time, cost, restricted anesthetic techniques and tongue lacerations. This systematic review and meta-analysis followed the Cochrane Group standards and PRISMA framework. It encompassed an extensive search through PubMed, Embase, and Web of Science up to December 2023, focusing on clinical and surgical outcomes of IONM in CMI surgery. Primary outcomes included the use of various IONM techniques, complication rates, clinical improvement, reoperation, and mortality. The review, registered at PROSPERO (CRD42024498996), included both prospective and retrospective studies, with rigorous selection and data extraction processes. Statistical analysis was conducted using R software. The review included 16 studies, comprising 1358 patients. It revealed that IONM techniques predominantly involved somatosensory evoked potentials (SSEPs), followed by motor evoked potentials (MEPs) and Brainstem auditory evoked potentials (BAEPs). The estimated risk of complications with IONM was 6% (95% CI: 2-11%; I2 = 89%), lower than previously reported rates without IONM. Notably, the clinical improvement rate post-surgery was high at 99% (95% CI: 98-100%; I2 = 56%). The analysis also showed lower reoperation rates in surgeries with IONM compared to those without. Interestingly, no mortality was observed in the included studies. This systematic review and meta-analysis indicate that intraoperative neuromonitoring in Chiari I malformation surgery is associated with favorable clinical outcomes, including lower complication and reoperation rates, and high rates of clinical improvement.

Acute Respiratory Failure Requiring Invasive Ventilation in Adults With Congenital Syringomyelia/Arnold-Chiari Malformations: A Systematic Review.

Arnold-Chiari malformations (ACM) and congenital syringomyelia/syrinx are rare neurological phenomenons that can present as acute respiratory failure and contribute to multiple extubation failures despite surgical intervention. A systematic review was conducted to scrutinize the current literature, screening 65 papers and including 12 papers (13 patients). Sixty-one percent of patients had type 1 ACM and 70% had a congenital syringomyelia. Neurosurgical intervention occurred in seven patients, five patients had at least one extubation failure which was due to apnea or reoccurrence of respiratory failure, and eight patients needed tracheostomies. The neurosurgical intervention aims to improve patient symptoms, but our data and current literature suggest that patients with these pathologies still undergo long ventilation weans and are not liberated from the ventilator due to ongoing respiratory failure.

Geometric morphometric analysis of the brainstem and cerebellum in Chiari I malformation.

Background: Chiari I malformation (CMI) is characterized by inferior descent of the cerebellar tonsils through the foramen magnum and is associated with headache and neck pain. Many morphometric research efforts have aimed to describe CMI anatomy in the midsagittal plane using classical measurement techniques such as linear dimensions and angles. These methods are less frequently applied to parasagittal features and may fall short in quantifying more intricate anatomy with fewer distinct homologous landmarks. Methods: Landmark-based geometric morphometric techniques were used to asses CMI morphology in five anatomical planes of interest. Results: Significant shape differences between CMI and age/sex-matched controls were found in the midsagittal (Pseudo-F = 5.4841, p = 0.001) and axial planes through the rostral medulla (Pseudo-F = 7.6319, p = 0.001). In addition to tonsillar descent, CMI principal component 1 (PC1) scores in the midsagittal protocol were associated with marked anterior concavity of the brainstem and generalized verticality of the cerebellum with anterior rotation of its anterior lobe. In the axial medulla/cerebellum protocol, CMI PC1 scores were associated with greater anterior-posterior (A-P) dimension with loss of medial-lateral (M-L) dimension. Discussion: These results suggest that CMI is associated with greater curvature of the brainstem and spinal cord, which may perturb normal neural activities and disrupt cerebrospinal fluid movements. Previous reports on the A-P diameter of the posterior fossa in CMI have conflicted; our findings of greater A-P cerebellar dimensionality with concomitant loss of width alludes to the possibility that more caudal aspects of the posterior cranial fossa are more bowl-like (homogenous in axial dimensions) and less trough-like or elongated in the M-L direction.

A Rare Case of Arnold Chiari Malformation Type 1 Presenting With Features of Catatonia.

The Arnold Chiari malformation is a congenital neurological condition. It occurs due to a defect in the cerebellum. Our patient is a 19-year-old postpartum female who presented to our ER with headaches, crying spells, reduced interaction, poor self-care, and neglect of her newborn for the past five days. Before the onset of her presenting symptoms, the patient had complained of a severe headache in the back of the head and dizziness. Her baseline investigations were normal. On examination, the patient was noticed to have a fixed gaze, ambiguity, mutism, and rigidity. So, she was diagnosed with catatonia, a differential diagnosis of mental and behavioral disorders associated with pregnancy, childbirth, and puerperium, and was treated with medications appropriately. As her headache showed minimal relief with adequate analgesic measures, neuroimaging was done, which showed Arnold Chiari malformation type I with hydrocephalus. A liaison was made with the neurology team, who confirmed the diagnosis and advised her on the decompression procedure. Her family refused to undergo the procedure. Once she showed minimal improvement in her symptoms, her family members requested her discharge. In our case, the Arnold Chiari malformation type I presented with features of catatonia, unlike the usual reported presentation of depression and anxiety. This case highlights the need for a thorough evaluation of any patient presenting with catatonia.

Emotional regulation and Arnold's self-ideal: a way to flourishment.

The convergence of researchers in the fields of flourishing, moral psychology, and social-emotional studies has reached a stage where developing a theory that connects emotional regulation and flourishing is meaningful. This theoretical investigation aims to uncover insights from the research of Magda B. Arnold, renowned for her theory of emotions, and lesser-known for her notion of the self-ideal, regarding the relationship between emotional regulation and flourishing. Our initial hypothesis posits that Arnold's concept of self-ideal provides a framework for understanding how to foster emotional regulation in individuals by directing it toward constructive life objectives. To achieve this, we explore the current state of emotional regulation and flourishing and the relationship between these concepts; we consider the interconnectedness of emotion and self-ideal within Arnold's theory and analyze its potential to serve as a foundation for building a theory relating flourishing and emotional regulation. We find in Arnold's theory substantial ideas about the relationship between emotional regulation, flourishing, and self-ideal, as well as emerging empirical research relating to these themes. We conclude that Arnold's research can serve as a catalyst for developing psychological intervention models that enhance emotional regulation and promote a flourishing life.

Anaesthetic management of obstetric patients with Chiari type I malformation: a retrospective case series and literature review.

The peripartum management of obstetric patients with Chiari type I malformation remains a challenge due to the degree of cerebellar tonsillar herniation and a paucity of published evidence. There is concern about neuraxial anaesthetic blocks and uncertainty regarding the optimum mode of delivery. We systematically searched the literature for the obstetric management of patients with Chiari type I malformation, independent of publication date and language. We also searched our local hospital database from December 2009 to December 2022 for all deliveries to patients with this condition. We identified 137 cases comprising 103 deliveries described in 40 publications that met our inclusion criteria; 34 deliveries were identified in our local database. There were 84 spontaneous vaginal deliveries, 52 caesarean deliveries, and one delivery by unknown modality. Sixty neuraxial blocks were performed; approximately half of these were epidural procedures for labour analgesia. Six patients had new or worsened symptoms following delivery, but it is unclear whether these were related to their Chiari malformation. We identified no cases with brainstem herniation or severe symptoms. We discuss our findings in relation to other published literature and address the concerns described. Our review reveals the use of a variety of modes of delivery and anaesthetic techniques and that most patients suffered no neurological complication. We conclude there is no of evidence to avoid any one approach to labour analgesia, delivery and anaesthesia. We propose a holistic, individualised and patient-centred approach with an appraisal of the risks and benefits to support shared-decision making.

Regression of Chiari malformation type 2 following early postnatal meningomyelocele repair-a retrospective observation from an institutional series of patients.

PURPOSE: Spontaneous regression of Chiari malformation type 2 (CM2) is observed rarely, as CM2 is associated with meningomyelocele (MMC) that is surgically repaired either pre- or early postnatally. While the radiological regression of CM2 occurs frequently following prenatal repair of MMC, it has been reported in only a few studies after postnatal repair. METHODS: From the consecutive series of children with postnatally repaired MMC, we reviewed the clinical and radiological data regarding CM2, particularly its regression either spontaneously or following CSF diversion. RESULTS: Eighteen children underwent postnatal repair of MMC between February 2011 and April 2023. CM2 was present in 16 (89%), and hydrocephalus in 15 children (83%), requiring shunting in 14 of them. During the mean clinical observation time (from birth to April 2023) of 59 ± 51 months, three children with CM2 (19%) underwent 1-2 foramen magnum decompressions (FMD), five children (28%) 1-4 surgical untethering procedures and 13 children with shunted hydrocephalus (93%) 1-5 shunt revisions. Out of sixteen children with CM2, we observed regression of CM2 on MRI in only one case (6%) during the mean radiological follow-up (from birth to the last MRI taken) of 49 ± 51 months. CONCLUSION: In our experience, spontaneous regression of CM2 in children with postnatally repaired MMC occurs quite rarely. Pathophysiological mechanisms behind the development of CM2 in children with MMC remain unclear, but our observation supports the hypothesis of an association between the downward displacement of the hindbrain and the low intraspinal pressure secondary to CSF leakage in children born with MMC.

Complex neural tube and skeletal malformations, resembling Chiari malformations, in two calves.

Two 1-day-old full-term female calves from different farms located in the Brazilian state of Rio Grande do Sul were unable to stand due to paresis of the pelvic limbs. Both calves had spina bifida on the spinal lumbar segment and were submitted to euthanasia due to poor prognosis. Postmortem examination revealed cerebellar herniation, caudal displacement of the brainstem, rostral deviation of the cranial nerves, caudal extension of occipital lobes, absence of dorsal lamina of lumbar vertebrae with exposed spinal cord, myelodysplasia, kyphosis, segmental spinal agenesis, renal fusion, muscular atrophy, and arthrogryposis. Histology highlighted myelodysplasia (syringomyelia and diplomyelia) and muscular atrophy. The reverse transcription-polymerase chain reactions for ruminant pestivirus were negative. Based on these lesions, the diagnosis of complex neural tube and skeletal malformations was made. A review of previous publications on calves diagnosed with these malformations, originally called Chiari or Arnold-Chiari malformations, revealed a wide range of nervous system and skeletal lesions. These variations amplified the uncertainty regarding whether all cases represent the same disorder and reinforced the importance of reconfiguring the terminology.

Dynamical Tunneling in More than Two Degrees of Freedom.

Recent progress towards understanding the mechanism of dynamical tunneling in Hamiltonian systems with three or more degrees of freedom (DoF) is reviewed. In contrast to systems with two degrees of freedom, the three or more degrees of freedom case presents several challenges. Specifically, in higher-dimensional phase spaces, multiple mechanisms for classical transport have significant implications for the evolution of initial quantum states. In this review, the importance of features on the Arnold web, a signature of systems with three or more DoF, to the mechanism of resonance-assisted tunneling is illustrated using select examples. These examples represent relevant models for phenomena such as intramolecular vibrational energy redistribution in isolated molecules and the dynamics of Bose-Einstein condensates trapped in optical lattices.

Malformación de Arnold Chiari / Arnold Chiari malformation

La malformación de Arnold Chiari es una enfermedad rara que consiste en una alteración anatómica de la base del cráneo, en la que se produce herniación del cerebelo y del tronco del encéfalo a través del foramen magnum hasta el canal cervical. Muchos niños afectados nunca llegan a tener síntomas. En el caso de que cause síntomas, estos no suelen aparecer hasta la infancia tardía o adolescencia. Presentamos el caso clínico de un paciente de 2 años con malformación de Arnold Chiari tipo I. (AU)

Arnold Chiari malformation is a rare disease that consists of an anatomical alteration of the base of the skull, in which herniation of the cerebellum and brainstem occurs through the foramen magnum to the cervical canal. Many affected children never develop symptoms. If it does cause symptoms, they usually don’t appear until late childhood or adolescence. We present the clinical case of a 2-year-old patient with Arnold Chiari malformation type I. (AU)

EEG-based biomarkers predict individual differences in TMS-induced entrainment of intrinsic brain rhythms.

BACKGROUND: Entrainment (increase) and modulation (shift) of intrinsic brain oscillations via rhythmic-TMS (rh-TMS) enables to either increase the amplitude of the individual peak oscillatory frequency, or experimentally slowing/accelerating this intrinsic peak oscillatory frequency by slightly shifting it. Both entrainment, and modulation of brain oscillations can lead to different measurable perceptual and cognitive changes. However, there are noticeable between-participant differences in such experimental entrainment outcomes. OBJECTIVE/HYPOTHESIS: The current study aimed at explaining these inter-individual differences in entrainment/frequency shift success. Here we hypothesize that the width and the height of the Arnold tongue, i.e., the frequency offsets that can still lead to oscillatory change, can be individually modelled via resting-state neural markers, and may explain and predict efficacy and limitation of successful rhythmic-TMS (rh-TMS) manipulation. METHODS: Spectral decomposition of resting-state data was used to extract the spectral curve of alpha activity, serving as a proxy of an individual Arnold tongue. These parameters were then used as predictors of the rh-TMS outcome, when increasing alpha-amplitude (i.e., applying pulse train tuned to the individual alpha frequency, IAF), or modulating the alpha-frequency (i.e., making alpha faster or slower by stimulating at IAF±1Hz frequencies). RESULTS: Our results showed that the height of the at-rest alpha curve predicted how well the entrainment increased the intrinsic oscillatory peak frequency, with a higher at-rest spectral curve negatively predicting amplitude-enhancement during entrainment selectively during IAF-stimulation. In contrast, the wider the resting-state alpha curve, the higher the modulation effects aiming to shift the intrinsic frequency towards faster or slower rhythms. CONCLUSION: These results not only offer a theoretical and experimental model for explaining the variance across different rh-TMS studies reporting heterogenous rh-TMS outcomes, but also introduce a potential biomarker and corresponding evaluative tool to develop most optimal and personalized rh-TMS protocols, both in research and clinical applications.

A case report of a neonate with Arnold Chiari II malformation.

Chiari malformations are structural defects in the cerebellum that are characterized by the downward displacement of one or both cerebellar tonsils through the foramen magnum. A case report of a female neonate with clinical features of Chiari II malformation is presented. The diagnosis of this condition was made through a combination of clinical and radiological features. In this case, the diagnosis was confirmed by a noncontrast computed tomography (CT) scan of the brain and multiplanar brain magnetic resonance imaging (MRI).

Blockchain based medical image encryption using Arnold's cat map in a cloud environment.

Improved software for processing medical images has inspired tremendous interest in modern medicine in recent years. Modern healthcare equipment generates huge amounts of data, such as scanned medical images and computerized patient information, which must be secured for future use. Diversity in the healthcare industry, namely in the form of medical data, is one of the largest challenges for researchers. Cloud environment and the Block chain technology have both demonstrated their own use. The purpose of this study is to combine both technologies for safe and secure transaction. Storing or sending medical data through public clouds exposes information into potential eavesdropping, data breaches and unauthorized access. Encrypting data before transmission is crucial to mitigate these security risks. As a result, a Blockchain based Chaotic Arnold's cat map Encryption Scheme (BCAES) is proposed in this paper. The BCAES first encrypts the image using Arnold's cat map encryption scheme and then sends the encrypted image into Cloud Server and stores the signed document of plain image into blockchain. As blockchain is often considered more secure due to its distributed nature and consensus mechanism, data receiver will ensure data integrity and authenticity of image after decryption using signed document stored into the blockchain. Various analysis techniques have been used to examine the proposed scheme. The results of analysis like key sensitivity analysis, key space analysis, Information Entropy, histogram correlation of adjacent pixels, Number of Pixel Change Rate, Peak Signal Noise Ratio, Unified Average Changing Intensity, and similarity analysis like Mean Square Error, and Structural Similarity Index Measure illustrated that our proposed scheme is an efficient encryption scheme as compared to some recent literature. Our current achievements surpass all previous endeavors, setting a new standard of excellence.

Analysis of DWT-DCT watermarking algorithm on digital medical imaging.

Purpose: Over the past decade, the diagnostic information of the patients are digitally recorded and transferred. During the transmission of patients data, the security and authenticity of the information has to be ensured. Medical image watermarking technology has recently advanced because it can be used to conceal patient information while ensuring the authenticity. We propose a multiple watermarking method for securing clinical medical images. Approach: In this watermarking method, the quality feature property and private label property information are embedded as watermarks in the original image. Initially, medical images are divided into the region of interest (ROI) and non-interest region (NIR). Second, a two-level discrete wavelet transform (DWT) is applied to the ROI and the coefficients LL1 (LL2, LH2, HL2, HH2), LH1, HL1, and HH1 are generated. Watermarks are embedded using the DWT low-frequency sub-band (LL2) by quantizing the low-frequency coefficients. Next, the NIR is separated into non-overlapping 8×8 blocks, and a discrete cosine transform (DCT) is applied for each block. The DCT coefficients of each block are sorted using the zigzag transform. For embedding, eight intermediate frequency coefficients are used. Finally, the feature information is embedded in the ROI, and the tag information is embedded in the NIR. Results: The performance of the DWT-DCT watermarking method is calculated using the metrics of peak signal-to-noise ratio (PSNR), structural similarity index measure, and mean square error. The proposed method obtained the better PSNR value of 45.76 dB. Conclusions: The proposed model works well for clinical medical images when compared with the existing techniques.

Clinical presentation and outcomes of neonates born with neural tube defects- an experience from a level III B NICU in Western India.

PURPOSE: Neural tube defects (NTDs) are one of the most common congenital anomalies and a cause of chronic disability. The study was done to study outcomes of neural tube defects admitted at a tertiary level neonatal intensive care unit (NICU) from 2018 to 2022, a period of 4 years that also coincided with the COVID pandemic. The secondary outcome was to study the clinical presentation, associated anomalies and epidemiological features. METHODS: It was a retrospective observational study; data of infants was obtained from medical records and analysis was done. RESULTS: Thirty-four neonates were enrolled, of which there were 16 (47%) males and 18 (53%) females. History of pre-pregnancy maternal folate intake was present in 4 (11.7%) cases. 33 (97%) babies were diagnosed with meningomyelocele (MMC) and one each had anencephaly, iniencephaly and encephalocele, of which one had frontal and two had occipital encephalocele. The median age of surgery was 16 days of life with primary repair being the most common procedure followed by MMC repair with VP shunt. Twenty babies (58.8%) were discharged successfully, while 9 (26.5%) expired and 5 (14.7%) were discharged against medical advice; which can be attributed to the financial problems of the patients in a developing country. The overall deaths in our series were four (26.5%) which is slightly higher than other studies which may be due to the fact that this study was conducted during the COVID era with lesser rates of folate supplementation, reduced access to prenatal diagnosis coupled with poor follow-up and compliance of patients post-surgical repair. CONCLUSION: This study emphasizes the importance of periconceptional folic acid supplementation, prenatal diagnosis, early surgery and meticulous follow-up as being pivotal to improving outcomes in children with NTDs.

Chiari type III malformation associated with Klippel-Feil syndrome, a case report with a narrative review of the literature.

BACKGROUND: Chiari malformation type III (CM III), a rare hindbrain anomaly, often presents with various concurrent anomalies. This paper reports a unique case of CM III associated with Klippel-Feil syndrome (KFS), a condition previously unreported in Saudi Arabia and documented in only one other case globally in Turkey. This study aims to share insights into the unusual association between CM III and KFS, considering their close embryological development and involvement in the craniocervical junction. METHODOLOGY: The study presents a case of a 2.5-year-old female diagnosed with CM III and KFS. Diagnostic tools such as ultrasound, CT scans, MRI, and physical examinations were used to confirm the patient's condition. Surgical interventions, including decompression and encephalocele repair, were performed. RESULTS: Successful surgical interventions, including encephalocele repair and duraplasty, were carried out. Follow-up visits indicated a stable condition, marked improvement in lower limb strength, and the patient's ability to walk with assistance. CT follow-up affirmed a satisfactory surgical outcome. CONCLUSION: This case study illustrates the potential for an optimistic prognosis in CM III, even when accompanied by complex conditions such as KFS, through early diagnosis and intervention. It underscores the significance of antenatal screening for effective care planning and calls for further research and publications due to the rarity of this association. These findings contribute to our understanding of CM III and its related conditions, emphasizing the need for open-minded consideration of potential embryological associations.

Dynamics, synchronization and traveling wave patterns of flux coupled network of Chay neurons.

Studies in the literature have demonstrated the significance of the synchronization of neuronal electrical activity for signal transmission and information encoding. In light of this importance, we investigate the synchronization of the Chay neuron model using both theoretical analysis and numerical simulations. The Chay model is chosen for its comprehensive understanding of neuronal behavior and computational efficiency. Additionally, we explore the impact of electromagnetic induction, leading to the magnetic flux Chay neuron model. The single neuron model exhibits rich and complex dynamics for various parameter choices. We explore the bifurcation structure of the model through bifurcation diagrams and Lyapunov exponents. Subsequently, we extend our study to two coupled magnetic flux Chay neurons, identifying mode locking and structures reminiscent of Arnold's tongue. We evaluate the stability of the synchronized manifold using Lyapunov theory and confirm our findings through simulations. Expanding our study to networks of diffusively coupled flux Chay neurons, we observe coherent, incoherent, and imperfect chimera patterns. Our investigation of three network types highlights the impact of network topology on the emergent dynamics of the Chay neuron network. Regular networks exhibit diverse patterns, small-world networks demonstrate a critical transition to coherence, and random networks showcase synchronization at specific coupling strengths. These findings significantly contribute to our understanding of the synchronization patterns exhibited by the magnetic flux Chay neuron. To assess the synchronization stability of the Chay neuron network, we employ master stability function analysis.

Disfagia orofaríngea na malformação de Chiari tipo I: série de casos clínicos / Oropharyngeal dysphagia in type I Chiari malformation: a clinical case series

RESUMO A malformação de Chiari tipo I é uma condição geralmente congênita de herniação das tonsilas cerebelares abaixo do forame magno, que pode levar à compressão das estruturas próximas da fossa craniana posterior ou à obstrução do fluxo do líquido cefalorraquidiano ventril. O tipo I, apesar de raro, é o mais comumente encontrado na população. Este estudo teve como objetivo relatar os achados da videoendoscopia da deglutição, avaliação fonoaudiológica, nível de ingestão oral, risco nutricional e o planejamento terapêutico em três casos de malformação de Chiari tipo I na fase adulta. Foram coletados dados com relação à avaliação fonoaudiológica de mobilidade e força de língua, Tempo Máximo de Fonação, eficiência da tosse e o Índice de Eichner. Foram analisados o nível de ingestão oral e os sinais faríngeos de disfagia em quatro consistências alimentares, de acordo com a classificação da International Dysphagia Diet Standartisation Initiative), por meio da videoendoscopia da deglutição. Para análise e classificação dos resíduos faríngeos, foi utilizado o Yale Pharyngeal Residue Severity Rating Scale, enquanto que, para rastrear o risco nutricional, foi utilizado o Malnutrition Screening Tool. Observou-se redução mobilidade e força de língua e no Tempo Máximo de Fonação, enquanto que os sinais faríngeos variaram entre os casos, com presença de fechamento glótico incompleto, escape oral posterior, deglutições múltiplas, resíduos faríngeos e penetração laríngea.

ABSTRACT Type I Chiari malformation (MCI) is a generally congenital condition of herniation of the cerebellar tonsils below the foramen magnum, which can lead to compression of structures close to the posterior cranial fossa or obstruction of the flow of ventral cerebrospinal fluid. Type I, although rare, is the most commonly found in the population. This study aimed to report the findings of video endoscopy of swallowing, speech assessment, level of oral intake, nutritional risk and therapeutic planning in three cases of Type I Chiari malformation. Data were collected regarding the assessment of mobility and strength of tongue, Maximum Phonation Time (MPT), cough efficiency and the Eichner Index. The level of oral intake and pharyngeal signs of dysphagia were analyzed in four food consistencies, according to the International Dysphagia Diet Standardization Initiative (IDDSI) classification, using swallowing video endoscopy. For analysis and classification of pharyngeal residues, the Yale Pharyngeal Residue Severity Rating Scale (YPRSRS) was used, while the Malnutrition Screening Tool (MST) was used to track nutritional risk. Reduced tongue mobility and strength and reduced MPT were observed, while pharyngeal signs varied between cases, with the presence of incomplete glottic closure, posterior oral escape, multiple swallows, pharyngeal residues and laryngeal penetration.