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September 10, 2025

Cough syncope and central sleep apnea caused by CM1 with atlas assimilation in adult: An illustrative case

Key Points

The patient experienced cough syncope and central sleep apnea, resolving after surgical intervention.
Magnetic resonance imaging confirmed Chiari type 1 malformation and accompanying syringomyelia.
Polysonogram testing indicated mild sleep apnea, prompting evaluation for surgical options.
Surgical decompression of the foramen magnum was successfully performed, leading to long-term stability.

Abstract

Background: Cough syncope, central sleep apnea (CSA), and Chiari type 1 malformations (CM1) with atlas assimilation are very rare in adults. Case Description: A 48-year-old male taxi driver fainted. He was neurologically intact, but tested positive for mild sleep apnea confirmed by a polysonogram. The magnetic resonance imaging diagnosed a CM1 with syringomyelia and atlas occipitalization. The patient underwent an uneventful foramen magnum decompression/C1 laminectomy and remained intact 7 years later. Conclusion: A 48-year-old male presented after fainting with cough syncope, CSA and a CM1; following foramen magnum decompression/C1 laminectomy, the patient remained neurologically stable for the next 7 years.

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