U.S. flag

An official website of the United States government

Format

Send to:

Choose Destination

Chiari malformation type II(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.

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

Lazzareschi I, Curatola A, Massimi L, Rendeli C, Rollo E, Scala I, Della Marca G, Brunetti V
J Clin Sleep Med 2022 Sep 1;18(9):2143-2154. doi: 10.5664/jcsm.10062. PMID: 35645039Free PMC Article
Fons K, Jnah AJ
Neonatal Netw 2021 Aug 1;40(5):313-320. doi: 10.1891/11-T-704. PMID: 34518383
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
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
Messing-Jünger M, Röhrig A
Childs Nerv Syst 2013 Sep;29(9):1553-62. Epub 2013 Sep 7 doi: 10.1007/s00381-013-2134-4. PMID: 24013325

Diagnosis

Lazzareschi I, Curatola A, Massimi L, Rendeli C, Rollo E, Scala I, Della Marca G, Brunetti V
J Clin Sleep Med 2022 Sep 1;18(9):2143-2154. doi: 10.5664/jcsm.10062. PMID: 35645039Free PMC Article
Fons K, Jnah AJ
Neonatal Netw 2021 Aug 1;40(5):313-320. doi: 10.1891/11-T-704. PMID: 34518383
Ridgway C, Bouhabel S, Martignetti L, Kishimoto Y, Li-Jessen NYK
JAMA Otolaryngol Head Neck Surg 2021 Aug 1;147(8):745-752. doi: 10.1001/jamaoto.2021.1050. PMID: 34110365
Dewan MC, Wellons JC
J Neurosurg Pediatr 2019 Aug 1;24(2):105-114. doi: 10.3171/2019.4.PEDS18383. PMID: 31370010
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

Therapy

Protzenko T, Bellas A, Pousa MS, Protzenko M, Fontes JM, de Lima Silveira AM, Sá CA, Pereira JP, Salomão RM, Salomão JFM, Dos Santos Gomes SC
Neurosurg Focus 2019 Oct 1;47(4):E2. doi: 10.3171/2019.7.FOCUS19462. PMID: 31574474
Dewan MC, Wellons JC
J Neurosurg Pediatr 2019 Aug 1;24(2):105-114. doi: 10.3171/2019.4.PEDS18383. PMID: 31370010
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
Greenberg JK, Olsen MA, Yarbrough CK, Ladner TR, Shannon CN, Piccirillo JF, Anderson RC, Wellons JC 3rd, Smyth MD, Park TS, Limbrick DD Jr
J Neurosurg Pediatr 2016 May;17(5):525-32. Epub 2016 Jan 22 doi: 10.3171/2015.10.PEDS15369. PMID: 26799408Free PMC Article
Gupta N, Farrell JA, Rand L, Cauldwell CB, Farmer D
J Neurosurg Pediatr 2012 Mar;9(3):265-73. doi: 10.3171/2011.12.PEDS11403. PMID: 22380954

Prognosis

Talamonti G, Marcati E, Mastino L, Meccariello G, Picano M, D'Aliberti G
Childs Nerv Syst 2020 Aug;36(8):1621-1634. Epub 2020 May 30 doi: 10.1007/s00381-020-04675-7. PMID: 32474814
Kim I, Hopson B, Aban I, Rizk EB, Dias MS, Bowman R, Ackerman LL, Partington MD, Castillo H, Castillo J, Peterson PR, Blount JP, Rocque BG
J Neurosurg Pediatr 2018 Dec 1;22(6):652-658. doi: 10.3171/2018.5.PEDS18160. PMID: 30141752Free PMC Article
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
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
Alsaadi MM, Iqbal SM, Elgamal EA, Gozal D
Pediatr Int 2012 Oct;54(5):623-6. Epub 2012 Jul 19 doi: 10.1111/j.1442-200X.2012.03660.x. PMID: 22564146

Clinical prediction guides

Ridgway C, Bouhabel S, Martignetti L, Kishimoto Y, Li-Jessen NYK
JAMA Otolaryngol Head Neck Surg 2021 Aug 1;147(8):745-752. doi: 10.1001/jamaoto.2021.1050. PMID: 34110365
Dewan MC, Wellons JC
J Neurosurg Pediatr 2019 Aug 1;24(2):105-114. doi: 10.3171/2019.4.PEDS18383. PMID: 31370010
Menezes AH, Greenlee JDW, Dlouhy BJ
J Neurosurg Pediatr 2018 Jul;22(1):52-60. Epub 2018 Apr 27 doi: 10.3171/2018.1.PEDS17472. PMID: 29701558
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
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

Recent systematic reviews

Pollenus J, Lagae L, Aertsen M, Jansen K
Eur J Paediatr Neurol 2020 Sep;28:16-28. Epub 2020 Jul 28 doi: 10.1016/j.ejpn.2020.07.005. PMID: 32771303

Supplemental Content

Table of contents

    Clinical resources

    Practice guidelines

    • PubMed
      See practice and clinical guidelines in PubMed. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.
    • Bookshelf
      See practice and clinical guidelines in NCBI Bookshelf. The search results may include broader topics and may not capture all published guidelines. See the FAQ for details.

    Recent activity

    Your browsing activity is empty.

    Activity recording is turned off.

    Turn recording back on

    See more...