{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,26]],"date-time":"2026-06-26T15:51:17Z","timestamp":1782489077227,"version":"3.54.5"},"reference-count":38,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T00:00:00Z","timestamp":1767916800000},"content-version":"unspecified","delay-in-days":8,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2025,12,26]]},"published-print":{"date-parts":[[2026,1]]},"abstract":"<jats:p>A woman in her early 40s presented with a 7-year history of recurrent choking episodes affecting solids and liquids, nocturnal choking episodes occurring 3\u20134 times weekly, and chronic occipital headaches spanning 14 years. Home monitoring during the COVID-19 pandemic incidentally revealed episodes of severe oxygen desaturation (70%\u201380%) without respiratory distress. Multiple laryngoscopies and endoscopies performed to investigate the choking episodes were normal. Review of a 14-year-old CT scan of the head performed for unrelated trauma revealed a previously overlooked crowded foramen magnum. MRI of the head and neck confirmed Chiari malformation type I (CMI) with 11\u2009mm cerebellar tonsillar descent. Sleep study demonstrated mild sleep apnoea (apnoea\u2013hypopnoea index 6.0) with predominantly central events (72%). This case illustrates that CMI can present with respiratory symptoms that closely mimic acquired central hypoventilation syndrome (Ondine\u2019s curse), emphasising the importance of considering structural brain abnormalities in patients with unexplained respiratory dysfunction.<\/jats:p>","DOI":"10.1136\/bcr-2025-269032","type":"journal-article","created":{"date-parts":[[2026,1,9]],"date-time":"2026-01-09T14:35:24Z","timestamp":1767969324000},"page":"e269032","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Central hypoventilation and choking episodes revealing Chiari malformation type I"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-2231-5906","authenticated-orcid":false,"given":"Ali Mohamed","family":"Mousa","sequence":"first","affiliation":[{"name":"Family Medicine, Kuwait Oil Company, Ahmadi, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5458-7780","authenticated-orcid":false,"given":"Mervat","family":"Mahmoud","sequence":"additional","affiliation":[{"name":"Family Medicine, Kuwait Oil Company, Ahmadi, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-5760-5358","authenticated-orcid":false,"given":"Ghaida Mubarak","family":"AlShuraiaan","sequence":"additional","affiliation":[{"name":"Family Medicine, Kuwait Oil Company, Ahmadi, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zouheir Ibrahim","family":"Bitar","sequence":"additional","affiliation":[{"name":"Internal Medicine, Kuwait Oil Company, Ahmadi, Kuwait"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,1,9]]},"reference":[{"key":"2026062608100971000_19.1.e269032.1","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1179\/016164111X12962202723689","article-title":"National Institutes of Health Chiari Research Conference: state of the research and new directions","volume":"33","author":"Labuda","year":"2011","journal-title":"Neurol Res"},{"key":"2026062608100971000_19.1.e269032.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.pediatrneurol.2019.12.005"},{"key":"2026062608100971000_19.1.e269032.3","doi-asserted-by":"crossref","first-page":"6694","DOI":"10.3390\/jcm12206694","article-title":"Chiari Syndrome: Advances in Epidemiology and Pathogenesis: A Systematic Review","volume":"12","author":"Rodr\u00edguez-Blanque","year":"2023","journal-title":"J Clin Med"},{"key":"2026062608100971000_19.1.e269032.4","first-page":"48","article-title":"Syringomyelia and Chiari Syndrome Registry: advances in epidemiology, clinical phenotypes and natural history based on a North Western Italy cohort","volume":"56","author":"Ciaramitaro","year":"2020","journal-title":"Ann Ist Super Sanita"},{"key":"2026062608100971000_19.1.e269032.5","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMra2308055"},{"key":"2026062608100971000_19.1.e269032.6","doi-asserted-by":"crossref","first-page":"1006","DOI":"10.3390\/brainsci14101006","article-title":"Chiari Formation or Malformation? 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