The Chiari malformations are a family of conditions characterized by developmental or, less commonly, acquired displacements of the cerebellum. The original 19th century description by Hans Chiari delineated 4 types, but only types 1 and 2 are more than just curiosities. In his initial description, Chiari classified the hindbrain malformations into type I, II and III and then latter added type IV malformation. Type IV is a very rare type. It is characterized by cerebellar hypoplasia or aplasia and tentorial hypoplasia. There is no hindbrain herniation in this type. We report a case of a 6 year old male patient who presented to us with a 6 year history of an occipitocervical mass and inability to stand and walk for one year and a 5 month history of headache and vomiting. CT scan of the brain showed a midline posterior fossa bone defect with a meningocele with active obstructive hydrocephalus and hypoplastic cerebellum without hindbrain herniation. A diagnosis of a posterior fossa congenital anomaly (Chiari 4) with obstructive hydrocephalus and occipito-cervical meningocele was made. Ventriculo-peritoneal shunt was inserted three days post admission. Patient was then electively taken to theatre five months later for repair of the occipitocervical meningocele.
Published in | Science Journal of Clinical Medicine (Volume 6, Issue 6) |
DOI | 10.11648/j.sjcm.20170606.12 |
Page(s) | 105-108 |
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This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited. |
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Copyright © The Author(s), 2017. Published by Science Publishing Group |
Chiari Type IV, Hydrocephalus, Meningocele, Hindbrain
[1] | Tubbs RS, Elton S, Grabb P, et al. Analysis of the posterior fossa in children with the Chiari 0 malformation. Neurosurgery. 2001; 48:1050-1055. |
[2] | Chiari H. Concerning alterations in the cerebellum resulting from cerebral hydrocephalus. PediatNeurosci. 1987; 13:3-8. |
[3] | L. P Rowland, T. A Pedley. Merritt’s Neurology. Lippincott William and Wikins, 12th edition, Philadelphia. 2010:590-594. |
[4] | P. Vannemreddy, A. Nourbakhsh, B. Willis, B. Guthikonda. Congenital Chiarimalformation. Neurology India. 2010; 58:6-14. |
[5] | Ashfaqul Hassan , Sabah Yaseen et al Arnold-Chiari Malformation: Anatomical Variations and Latest Embryological Perspective. Review of Literature| Volume 3 | Issue 5 | May 2016. |
[6] | Banerji NK, Millar JHD: Chiari malformation presenting in adult life. Brain 97:157-168, 1974. |
[7] | American Syringomyelia Alliance Project Inc. C&S Patient Education Foundation The World Arnold Chiari Malformation Association. |
[8] | Milhorat TM, Nishikawa M, Kula RW, Dlugacz YD. Mechanisms of cerebellar tonsil herniation in patients with Chiari malformations as a guide to clinical management. Acta Neurochir. 2010; 152:1117-1127. |
[9] | Boyles A, Enterline D, Hammock P et al. Phenotypic definition of Chiari type Imalformation coupled with high-density SNP genome screen shows significant evidence for linkage to regions on chromosomes 9 and 15. Am J Med Genet 2006. |
[10] | Urbizu A, Toma C, Poca M et al. Chiari Malformation Type I: A Case-ControlAssociation Study of 58 Developmental Genes. 2013; 8(2). |
[11] | Ye S. Bioinformatics Boca Raton [u. a]: Taylor & Francis; 2008. |
[12] | Bejjani, Cockerham. Adult Chiari Malformation. 1st ed. Pittsburgh, PA; 2015. |
[13] | Avellaneda Fernández A, Isla Guerrero A, Izquierdo Martínez M et al. Malformations of the craniocervical junction (chiari type I and syringomyelia: classification, diagnosis and treatment). BMC Musculoskeletal Disorders. 2009; 10 (Suppl 1). |
[14] | Barone CM, Jimenez DF, Helling ER, LaskeyALS: What is the incidence of hypertelorism in Filipino frontonasal encephalocele patients?J Craniofac Surg 2007; 18: 268–273. |
[15] | Bozinov O, Tirakotai W, Sure U, BertalanffyH: Surgical closure and reconstruction of alarge occipital encephalocele without parenchymalexcision. Childs Nerv Syst 2005; 21:144–147. |
[16] | Raja RA, Qureshi AA, Memon AR, Ali H, Dev V: Pattern of encephaloceles: a case series. J Ayub Med Coll Abbottabad 2008; 20: 125–128. |
[17] | Antunes JL, Sharer LR, Pellock JM: Occipitalencephaloce – A case of conjoined twinning? Neurosurgery 1983; 13: 703–707. |
[18] | Aslan A, Eser O, Doğru O, Aktepe F, Yurumez Y: Occipital mega encephalocele associated with acute inflammation. Pediatr Neurosurg 2007; 43: 65–66. |
[19] | Moorthy RK, Rajshekhar V: Management of hydrocephalus associated with occipital encephalocele using endoscopic third ventriculostomy: report of two cases. Surg Neurol 2002; 57: 351–355. |
[20] | Andarabi Y, Nejat F, El-Khashab M: Progressive skin necrosis of a huge occipital encephalocele. Indian J Plast Surg 2008; 41: 82–84. |
[21] | Kotil K, Kilinc B, Bilge T: Diagnosis and management of large occipitocervical cephaloceles:a 10 year experience. Pediatr Neurosurg 2008; 44: 193–198. |
[22] | Ashfaq Ul Hassan, A Giant Occipital Encephalocele Universal Journal of Applied Science 1(1): 8-10, 2013. |
APA Style
Kelvin Nemayire, Kantenga Dieu merci Kabulo, Nathaniel Zimani, Nyararai Togarepi, Musara Aaron, et al. (2017). A Rare Case of Chiari Malformation Type 4. Science Journal of Clinical Medicine, 6(6), 105-108. https://doi.org/10.11648/j.sjcm.20170606.12
ACS Style
Kelvin Nemayire; Kantenga Dieu merci Kabulo; Nathaniel Zimani; Nyararai Togarepi; Musara Aaron, et al. A Rare Case of Chiari Malformation Type 4. Sci. J. Clin. Med. 2017, 6(6), 105-108. doi: 10.11648/j.sjcm.20170606.12
AMA Style
Kelvin Nemayire, Kantenga Dieu merci Kabulo, Nathaniel Zimani, Nyararai Togarepi, Musara Aaron, et al. A Rare Case of Chiari Malformation Type 4. Sci J Clin Med. 2017;6(6):105-108. doi: 10.11648/j.sjcm.20170606.12
@article{10.11648/j.sjcm.20170606.12, author = {Kelvin Nemayire and Kantenga Dieu merci Kabulo and Nathaniel Zimani and Nyararai Togarepi and Musara Aaron and Kazadi Kaluile Ntenga Kalangu}, title = {A Rare Case of Chiari Malformation Type 4}, journal = {Science Journal of Clinical Medicine}, volume = {6}, number = {6}, pages = {105-108}, doi = {10.11648/j.sjcm.20170606.12}, url = {https://doi.org/10.11648/j.sjcm.20170606.12}, eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.sjcm.20170606.12}, abstract = {The Chiari malformations are a family of conditions characterized by developmental or, less commonly, acquired displacements of the cerebellum. The original 19th century description by Hans Chiari delineated 4 types, but only types 1 and 2 are more than just curiosities. In his initial description, Chiari classified the hindbrain malformations into type I, II and III and then latter added type IV malformation. Type IV is a very rare type. It is characterized by cerebellar hypoplasia or aplasia and tentorial hypoplasia. There is no hindbrain herniation in this type. We report a case of a 6 year old male patient who presented to us with a 6 year history of an occipitocervical mass and inability to stand and walk for one year and a 5 month history of headache and vomiting. CT scan of the brain showed a midline posterior fossa bone defect with a meningocele with active obstructive hydrocephalus and hypoplastic cerebellum without hindbrain herniation. A diagnosis of a posterior fossa congenital anomaly (Chiari 4) with obstructive hydrocephalus and occipito-cervical meningocele was made. Ventriculo-peritoneal shunt was inserted three days post admission. Patient was then electively taken to theatre five months later for repair of the occipitocervical meningocele.}, year = {2017} }
TY - JOUR T1 - A Rare Case of Chiari Malformation Type 4 AU - Kelvin Nemayire AU - Kantenga Dieu merci Kabulo AU - Nathaniel Zimani AU - Nyararai Togarepi AU - Musara Aaron AU - Kazadi Kaluile Ntenga Kalangu Y1 - 2017/11/07 PY - 2017 N1 - https://doi.org/10.11648/j.sjcm.20170606.12 DO - 10.11648/j.sjcm.20170606.12 T2 - Science Journal of Clinical Medicine JF - Science Journal of Clinical Medicine JO - Science Journal of Clinical Medicine SP - 105 EP - 108 PB - Science Publishing Group SN - 2327-2732 UR - https://doi.org/10.11648/j.sjcm.20170606.12 AB - The Chiari malformations are a family of conditions characterized by developmental or, less commonly, acquired displacements of the cerebellum. The original 19th century description by Hans Chiari delineated 4 types, but only types 1 and 2 are more than just curiosities. In his initial description, Chiari classified the hindbrain malformations into type I, II and III and then latter added type IV malformation. Type IV is a very rare type. It is characterized by cerebellar hypoplasia or aplasia and tentorial hypoplasia. There is no hindbrain herniation in this type. We report a case of a 6 year old male patient who presented to us with a 6 year history of an occipitocervical mass and inability to stand and walk for one year and a 5 month history of headache and vomiting. CT scan of the brain showed a midline posterior fossa bone defect with a meningocele with active obstructive hydrocephalus and hypoplastic cerebellum without hindbrain herniation. A diagnosis of a posterior fossa congenital anomaly (Chiari 4) with obstructive hydrocephalus and occipito-cervical meningocele was made. Ventriculo-peritoneal shunt was inserted three days post admission. Patient was then electively taken to theatre five months later for repair of the occipitocervical meningocele. VL - 6 IS - 6 ER -