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Chiari type II malformation(CM2)

MedGen UID:
108222
Concept ID:
C0555206
Congenital Abnormality
Synonyms: Arnold Chiari malformation type II; Chiari malformation type 2; CM2
SNOMED CT: Chiari malformation type II (373587001); Arnold Chiari type 2 (373587001)
 
HPO: HP:0025660
Monarch Initiative: MONDO:0008816
OMIM®: 207950

Definition

Chiari malformation type II (CM2), also known as the Arnold-Chiari malformation, consists of elongation and descent of the inferior cerebellar vermis, cerebellar hemispheres, pons, medulla, and fourth ventricle through the foramen magnum into the spinal canal. CM2 is uniquely associated with myelomeningocele (open spina bifida; see 182940) and is found only in this population (Stevenson, 2004). It is believed to be a disorder of neuroectodermal origin (Schijman, 2004). For a general phenotypic description of the different forms of Chiari malformations, see Chiari malformation type I (CM1; 118420). [from OMIM]

Clinical features

From HPO
Occipital neuralgia
MedGen UID:
507542
Concept ID:
C0007863
Disease or Syndrome
A distinct type of headache characterized by piercing, throbbing, or electric-shock-like chronic pain in the upper neck, back of the head, and behind the ears, usually on one side.
Limb muscle weakness
MedGen UID:
107956
Concept ID:
C0587246
Finding
Reduced strength and weakness of the muscles of the arms and legs.
Dysphagia
MedGen UID:
41440
Concept ID:
C0011168
Disease or Syndrome
Difficulty in swallowing.
Feeding difficulties
MedGen UID:
65429
Concept ID:
C0232466
Finding
Impaired ability to eat related to problems gathering food and getting ready to suck, chew, or swallow it.
Chiari malformation
MedGen UID:
2065
Concept ID:
C0003803
Congenital Abnormality
Chiari malformation consists of a downward displacement of the cerebellar tonsils and the medulla through the foramen magnum, sometimes causing hydrocephalus as a result of obstruction of CSF outflow.
Cerebellar ataxia
MedGen UID:
849
Concept ID:
C0007758
Disease or Syndrome
Cerebellar ataxia refers to ataxia due to dysfunction of the cerebellum. This causes a variety of elementary neurological deficits including asynergy (lack of coordination between muscles, limbs and joints), dysmetria (lack of ability to judge distances that can lead to under- or overshoot in grasping movements), and dysdiadochokinesia (inability to perform rapid movements requiring antagonizing muscle groups to be switched on and off repeatedly).
Hydrocephalus
MedGen UID:
9335
Concept ID:
C0020255
Disease or Syndrome
Hydrocephalus is an active distension of the ventricular system of the brain resulting from inadequate passage of CSF from its point of production within the cerebral ventricles to its point of absorption into the systemic circulation.
Myelomeningocele
MedGen UID:
7538
Concept ID:
C0025312
Congenital Abnormality
Protrusion of the meninges and portions of the spinal cord through a defect of the vertebral column.
Syringomyelia
MedGen UID:
21449
Concept ID:
C0039144
Disease or Syndrome
Dilated, glial-lined cavity in spinal cord. This cavity does not communicate with the central canal, and usually is between the dorsal columns unilaterally or bilaterally along the side of the cord.
Spina bifida
MedGen UID:
38283
Concept ID:
C0080178
Congenital Abnormality
Incomplete closure of the embryonic neural tube, whereby some vertebral arches remain unfused and open. The mildest form is spina bifida occulta, followed by meningocele and meningomyelocele.
Cervical myelopathy
MedGen UID:
57691
Concept ID:
C0149645
Disease or Syndrome
Opisthotonus
MedGen UID:
56246
Concept ID:
C0151818
Sign or Symptom
Corpus callosum, agenesis of
MedGen UID:
104498
Concept ID:
C0175754
Congenital Abnormality
The corpus callosum is the largest fiber tract in the central nervous system and the major interhemispheric fiber bundle in the brain. Formation of the corpus callosum begins as early as 6 weeks' gestation, with the first fibers crossing the midline at 11 to 12 weeks' gestation, and completion of the basic shape by age 18 to 20 weeks (Schell-Apacik et al., 2008). Agenesis of the corpus callosum (ACC) is one of the most frequent malformations in brain with a reported incidence ranging between 0.5 and 70 in 10,000 births. ACC is a clinically and genetically heterogeneous condition, which can be observed either as an isolated condition or as a manifestation in the context of a congenital syndrome (see MOLECULAR GENETICS and Dobyns, 1996). Also see mirror movements-1 and/or agenesis of the corpus callosum (MRMV1; 157600). Schell-Apacik et al. (2008) noted that there is confusion in the literature regarding radiologic terminology concerning partial absence of the corpus callosum, where various designations have been used, including hypogenesis, hypoplasia, partial agenesis, or dysgenesis.
Gray matter heterotopia
MedGen UID:
452349
Concept ID:
C0266491
Finding
Heterotopia or neuronal heterotopia are macroscopic clusters of misplaced neurons (gray matter), most often situated along the ventricular walls or within the subcortical white matter.
Bulbar signs
MedGen UID:
347246
Concept ID:
C1856507
Finding
Hypotonia
MedGen UID:
10133
Concept ID:
C0026827
Finding
Hypotonia is an abnormally low muscle tone (the amount of tension or resistance to movement in a muscle). Even when relaxed, muscles have a continuous and passive partial contraction which provides some resistance to passive stretching. Hypotonia thus manifests as diminished resistance to passive stretching. Hypotonia is not the same as muscle weakness, although the two conditions can co-exist.
Generalized hypotonia
MedGen UID:
346841
Concept ID:
C1858120
Finding
Generalized muscular hypotonia (abnormally low muscle tone).
Inspiratory stridor
MedGen UID:
146165
Concept ID:
C0677600
Sign or Symptom
Inspiratory stridor is a high pitched sound upon inspiration that is generally related to laryngeal abnormalities.
Cyanosis
MedGen UID:
1189
Concept ID:
C0010520
Sign or Symptom
Bluish discoloration of the skin and mucosa due to poor circulation or inadequate oxygenation of arterial or capillary blood.
Nystagmus
MedGen UID:
45166
Concept ID:
C0028738
Disease or Syndrome
Rhythmic, involuntary oscillations of one or both eyes related to abnormality in fixation, conjugate gaze, or vestibular mechanisms.

Conditions with this feature

Lathosterolosis
MedGen UID:
375885
Concept ID:
C1846421
Disease or Syndrome
Lathosterolosis (LATHOS) is an autosomal recessive disorder characterized by a recognizable pattern of multiple congenital anomalies involving axial and appendicular skeleton, liver, central nervous and urogenital systems, and lysosomal storage. It is caused by a defect of cholesterol biosynthesis due to sterol C5-desaturase deficiency (summary by Rossi et al., 2007).
Spondylocostal dysostosis 4, autosomal recessive
MedGen UID:
462292
Concept ID:
C3150942
Disease or Syndrome
Spondylocostal dysostosis (SCDO), defined radiographically as multiple segmentation defects of the vertebrae (M-SDV) in combination with abnormalities of the ribs, is characterized clinically by: a short trunk in proportion to height; short neck; non-progressive mild scoliosis in most affected individuals, and occasionally, more significant scoliosis. Respiratory function in neonates may be compromised by reduced size of the thorax. By age two years lung growth may improve sufficiently to support relatively normal growth and development; however, even then life-threatening complications can occur, especially pulmonary hypertension in children with severely restricted lung capacity from birth. Males with SCDO appear to be at increased risk for inguinal hernia.

Professional guidelines

PubMed

Spoor JKH, Gadjradj PS, Eggink AJ, DeKoninck PLJ, Lutters B, Scheepe JR, van Meeteren J, de Laat PCJ, van Veelen ML, de Jong THR
Neurosurg Focus 2019 Oct 1;47(4):E3. doi: 10.3171/2019.7.FOCUS19447. PMID: 31574477
Sepulveda W, Wong AE, Sepulveda F, Alcalde JL, Devoto JC, Otayza F
Childs Nerv Syst 2017 Jul;33(7):1083-1099. Epub 2017 Jun 7 doi: 10.1007/s00381-017-3445-7. PMID: 28593553
Manning SM, Jennings R, Madsen JR
Ment Retard Dev Disabil Res Rev 2000;6(1):6-14. doi: 10.1002/(SICI)1098-2779(2000)6:1<6::AID-MRDD2>3.0.CO;2-B. PMID: 10899792

Recent clinical studies

Etiology

McDowell MM, Blatt JE, Deibert CP, Zwagerman NT, Tempel ZJ, Greene S
J Neurosurg Pediatr 2018 Jun;21(6):587-596. Epub 2018 Mar 23 doi: 10.3171/2018.1.PEDS17496. PMID: 29570035
Beuriat PA, Szathmari A, Rousselle C, Sabatier I, Di Rocco F, Mottolese C
World Neurosurg 2017 Dec;108:62-68. Epub 2017 Sep 1 doi: 10.1016/j.wneu.2017.08.152. PMID: 28867320
Salman MS
Childs Nerv Syst 2011 Mar;27(3):457-62. Epub 2011 Jan 11 doi: 10.1007/s00381-010-1359-8. PMID: 21221976Free PMC Article
Salman MS, Sharpe JA, Lillakas L, Dennis M, Steinbach MJ
J Child Neurol 2009 Feb;24(2):161-5. doi: 10.1177/0883073808322326. PMID: 19182152Free PMC Article
Salman MS, Sharpe JA, Eizenman M, Lillakas L, To T, Westall C, Steinbach MJ, Dennis M
Can J Neurol Sci 2006 Nov;33(4):372-8. doi: 10.1017/s0317167100005321. PMID: 17168162

Diagnosis

Darouich S
Fetal Pediatr Pathol 2021 Dec;40(6):697-701. Epub 2020 Feb 25 doi: 10.1080/15513815.2020.1732508. PMID: 32096430
Sepulveda W, Wong AE, Sepulveda F, Alcalde JL, Devoto JC, Otayza F
Childs Nerv Syst 2017 Jul;33(7):1083-1099. Epub 2017 Jun 7 doi: 10.1007/s00381-017-3445-7. PMID: 28593553
Bosemani T, Poretti A
Semin Fetal Neonatal Med 2016 Oct;21(5):339-48. Epub 2016 May 12 doi: 10.1016/j.siny.2016.04.014. PMID: 27184462
Kıymaz N, Yılmaz N, Güdü BO, Demir I, Kozan A
Pediatr Neurosurg 2010;46(5):351-6. Epub 2011 Feb 24 doi: 10.1159/000323414. PMID: 21346398
Stevenson KL
Neurosurg Focus 2004 Feb 15;16(2):E5. doi: 10.3171/foc.2004.16.2.6. PMID: 15209488

Therapy

Hashiguchi K, Morioka T, Murakami N, Togao O, Hiwatashi A, Ochiai M, Eriguchi G, Kishimoto J, Iihara K
Childs Nerv Syst 2016 Jun;32(6):1069-78. Epub 2016 Mar 2 doi: 10.1007/s00381-016-3041-2. PMID: 26936599
de Oliveira RS, Barbosa A, Vicente YA, Machado HR
Childs Nerv Syst 2007 Jan;23(1):85-90. Epub 2006 Aug 30 doi: 10.1007/s00381-006-0183-7. PMID: 16944175
Northrup H, Volcik KA
Curr Probl Pediatr 2000 Nov-Dec;30(10):313-32. doi: 10.1067/mpp.2000.112052. PMID: 11147289
Manning SM, Jennings R, Madsen JR
Ment Retard Dev Disabil Res Rev 2000;6(1):6-14. doi: 10.1002/(SICI)1098-2779(2000)6:1<6::AID-MRDD2>3.0.CO;2-B. PMID: 10899792
Milerad J, Lagercrantz H, Johnson P
Acta Paediatr 1992 Aug;81(8):609-12. doi: 10.1111/j.1651-2227.1992.tb12311.x. PMID: 1392385

Prognosis

McDowell MM, Blatt JE, Deibert CP, Zwagerman NT, Tempel ZJ, Greene S
J Neurosurg Pediatr 2018 Jun;21(6):587-596. Epub 2018 Mar 23 doi: 10.3171/2018.1.PEDS17496. PMID: 29570035
Beuriat PA, Szathmari A, Rousselle C, Sabatier I, Di Rocco F, Mottolese C
World Neurosurg 2017 Dec;108:62-68. Epub 2017 Sep 1 doi: 10.1016/j.wneu.2017.08.152. PMID: 28867320
Poretti A, Boltshauser E, Huisman TA
Neuroimaging Clin N Am 2016 Aug;26(3):359-72. doi: 10.1016/j.nic.2016.03.006. PMID: 27423799
Bosemani T, Poretti A
Semin Fetal Neonatal Med 2016 Oct;21(5):339-48. Epub 2016 May 12 doi: 10.1016/j.siny.2016.04.014. PMID: 27184462
Hashiguchi K, Morioka T, Murakami N, Togao O, Hiwatashi A, Ochiai M, Eriguchi G, Kishimoto J, Iihara K
Childs Nerv Syst 2016 Jun;32(6):1069-78. Epub 2016 Mar 2 doi: 10.1007/s00381-016-3041-2. PMID: 26936599

Clinical prediction guides

McDowell MM, Blatt JE, Deibert CP, Zwagerman NT, Tempel ZJ, Greene S
J Neurosurg Pediatr 2018 Jun;21(6):587-596. Epub 2018 Mar 23 doi: 10.3171/2018.1.PEDS17496. PMID: 29570035
Oushy S, Parker JJ, Campbell K, Palmer C, Wilkinson C, Stence NV, Handler MH, Mirsky DM
J Neurosurg Pediatr 2017 Nov;20(5):432-438. Epub 2017 Sep 8 doi: 10.3171/2017.6.PEDS16481. PMID: 28885094
Hashiguchi K, Morioka T, Murakami N, Togao O, Hiwatashi A, Ochiai M, Eriguchi G, Kishimoto J, Iihara K
Childs Nerv Syst 2016 Jun;32(6):1069-78. Epub 2016 Mar 2 doi: 10.1007/s00381-016-3041-2. PMID: 26936599
Otera Y, Morokuma S, Fukushima K, Anami A, Yumoto Y, Ito Y, Ochiai M, Hashiguchi K, Wake N, Sago H, Kato K
BMC Res Notes 2015 Feb 27;8:57. doi: 10.1186/s13104-015-1014-2. PMID: 25890237Free PMC Article
McLendon RE, Crain BJ, Oakes WJ, Burger PC
Clin Neuropathol 1985 Sep-Oct;4(5):200-5. PMID: 4064385

Recent systematic reviews

Maroufi SF, Dabbagh Ohadi MA, Hosseinnejad I, Tayebi Meybodi K, Takzare A, Ashjaei B, Nejat F, Habibi Z
J Neurosurg Pediatr 2024 Jan 1;33(1):44-58. Epub 2023 Oct 20 doi: 10.3171/2023.8.PEDS23271. PMID: 37862714

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