Arnold-Chiari malformation pathophysiology
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Fahimeh Shojaei, M.D.
Overview
The exact pathogenesis of Arnol-Chiari malformation is not fully understood but It is thought that Arnol-Chiari malformation is the result of bone developmental abnormalities or mesodermal growth and differentiation abnormalities. Genes involved in the pathogenesis of Arnold-Chiari malformation include PAX1, PAX2, PAX3, PAX6, FGF2, TBX6, HOX gene, Noggin gene, and EFNB1. Conditions associated with Arnold-Chiari malformation include hydrocephalus, syringomyelias,Tethered spinal cord syndrome, neurofibromatosis type 1, Noonan syndrome, Pierre Robin sequence, Klippel-Feil syndrome, Albright hereditary osteodystrophy, x-linked aqueductal stenosis, Goldenhar syndrome, Williams syndrome, Shprintzen- goldberg syndrome, achondroplasia, familial osteosclerosis, velocardiofacial syndrome, and connective tissue disorders.
Pathophysiology
Pathogenesis
- The exact pathogenesis of Arnol-Chiari malformation is not fully understood but It is thought that Arnol-Chiari malformation is the result of cascade of anomalies that lead to:
- Bone developmental abnormalities
- Mesodermal growth and differentiation abnormalities
- These anomalies can be congenital as a result of developmental error or acquired.
- All the potential causes of Chiari malformation will lead to posterior cranial fossa abnormalities and subsequently herniation of cerebellar and/or other structures from foramen magnum.
Genetics
- Genes involved in the pathogenesis of Arnold-Chiari malformation include:[1]
- There are many findings emphasizing on genetic basic of Chiari malformation including:
- Many studies described higher prevalence of Chiari malformation among mono zygote twins or between family members.
- There are some evidence showing autosomal dominant/ recessive transmission.
- There are many genetic conditions that have association with Chiari malformation.
Associated Conditions
Conditions associated with Arnold-Chiari malformation include:[2][3][4][5][6][7]
- Hydrocephalus
- Syringomyelias
- Tethered spinal cord syndrome
- Neurofibromatosis type 1
- Noonan syndrome
- Pierre Robin sequence
- Klippel-Feil syndrome
- Albright hereditary osteodystrophy
- X-linked aqueductal stenosis
- Goldenhar syndrome
- Williams syndrome
- Shprintzen- goldberg syndrome
- Achondroplasia
- Familial osteosclerosis
- Velocardiofacial syndrome
- Connective tissue disorders such as:
Gross Pathology
On gross pathology, there is no characteristic finding of Chiari malfromation.
Microscopic Pathology
On microscopic pathology, there is enlaged, dysplastic / reactive fibrous tissue and choroid plexus in a Chiari II malformation.
References
- ↑ Schanker, Benjamin D.; Walcott, Brian P.; Nahed, Brian V.; Kahle, Kristopher T.; Li, Yan Michael; Coumans, Jean-Valery C. E. (2011). "Familial Chiari malformation: case series". Neurosurgical Focus. 31 (3): E1. doi:10.3171/2011.6.FOCUS11104. ISSN 1092-0684.
- ↑ "Neuropathology For Medical Students".
- ↑ Milhorat TH, Bolognese PA, Nishikawa M, McDonnell NB, Francomano CA (2007). "Syndrome of occipitoatlantoaxial hypermobility, cranial settling, and chiari malformation type I in patients with hereditary disorders of connective tissue". Journal of Neurosurgery: Spine. 7 (6): 601–9. doi:10.3171/SPI-07/12/601. PMID 18074684. Unknown parameter
|month=ignored (help) - ↑ Holder-Espinasse M, Abadie V, Cormier-Daire V, Beyler C, Manach Y, Munnich A, Lyonnet S, Couly G, Amiel J (October 2001). "Pierre Robin sequence: a series of 117 consecutive cases". J. Pediatr. 139 (4): 588–90. doi:10.1067/mpd.2001.117784. PMID 11598609.
- ↑ Tubbs RS, Rutledge SL, Kosentka A, Bartolucci AA, Oakes WJ (April 2004). "Chiari I malformation and neurofibromatosis type 1". Pediatr. Neurol. 30 (4): 278–80. doi:10.1016/j.pediatrneurol.2003.09.013. PMID 15087107.
- ↑ Schanker, Benjamin D.; Walcott, Brian P.; Nahed, Brian V.; Kahle, Kristopher T.; Li, Yan Michael; Coumans, Jean-Valery C. E. (2011). "Familial Chiari malformation: case series". Neurosurgical Focus. 31 (3): E1. doi:10.3171/2011.6.FOCUS11104. ISSN 1092-0684.
- ↑ Holder-Espinasse M, Winter RM (October 2003). "Type 1 Arnold-Chiari malformation and Noonan syndrome. A new diagnostic feature?". Clin. Dysmorphol. 12 (4): 275. doi:10.1097/01.mcd.0000081505.97834.0a. PMID 14564218.