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Chronic tonsillar herniation

An attempt at classifying chronic herniations at theforamen magnum

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Summary

A system is presented for the classification of chronic herniations of the cerebellar tonsils in the absence of space-occupying intracranial lesions, based on a survey of the literature and 13 own cases. The Arnold-Chiari malformation in adults typically involves herniation of the cerebellar tonsils instead of herniation of the vermis as is typical when it occurs in infancy. Identification of chronic tonsillar herniation with the Arnold-Chiari malformation in adults was thought to require at least one other sign of the Arnold-Chiari complex, e. g. a medullary deformity. Cases for which chronic herniation and sclerosis of the cerebellar tonsils present as the only nervous lesion are classified as “chronic tonsillar herniation”. Such cases may manifest with neurological symptoms during adult life, or they may be found incidentally at autopsy. Attention is drawn to the occurence of chronic tonsillar herniation in 7 infants and children where it apparently represent a cause of sudden unexpected death. The overlap between chronic tonsillar herniation and the Arnold-Chiari malformation of adults is discussed in regard to the frequence of associated osseous anomalies, hydrocephalus and syringomyelia.

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References

  • Adams, R. D., Schatzki, R., Scoville, W. B.: The Arnold-Chiari malformation. New Engl. J. Med.225, 125–135 (1941)

    Google Scholar 

  • Alvord, E. C., Jr.: The pathology of hydrocephalus. In: Disorders of developing nervous system, pp. 343–412. Springfield, Ill: Ch. C. Thomas 1961

    Google Scholar 

  • Appleby, A., et al.: The diagnosis and management of the Chiari anomalies in adult life. Brain91, 131–139 (1968)

    Google Scholar 

  • Aring, C. D.: Cerebellar syndrome in adult with malformation of cerebellum and brain stem (Arnold-Chiari malformation) with note occurrence of “torpedos” in cerebellum. J. Neurol. Psychiat.1, 100–109 (1938)

    Google Scholar 

  • Arnold, J.: Myelocyste, Transposition von Gewebskeimen und Sympodie. Zieglers Beitr. path. Anat.16, 1–28 (1894)

    Google Scholar 

  • Banerji, N. K. Millar, J. H. D.: Chiari malformation presenting in adult life. Its relationship to syringomyelia. Brain97, 157–168 (1974)

    Google Scholar 

  • Bedi, S. S.: Arnold-Chiari malformation presenting as syringomyelia. Ann. phys. Med.10, 16–17 (1969)

    Google Scholar 

  • Bucy, P. C., Lichtenstein, B. W.: Arnold-Chiari deformity in an adult without obvious cause. J. Neurosurg.2, 245–250 (1945)

    Google Scholar 

  • Carmel, P. W., Markesbery, W. R.: Arnold-Chiari malformation in an elderly woman. Arch. Neurol. (Chic.)21, 258–262 (1969)

    Google Scholar 

  • Chaouat, Y., Kanovitch, B., Faures, B., Aubin, M., Aboulker, J.: La Malformation de Chiari. A propos de 7 observations decouvertes dans un service de Rhumatologie. Rev. Rhum.39, 115–122 (1972)

    Google Scholar 

  • Chiari, H.: Über Veränderungen des Kleinhirns, der Pons und der Medulla oblongata in Folge von congenitaler Hydrocephalie des Großhirns. Dtsch. med. Wschr.17, 1172–1175 (1891)

    Google Scholar 

  • Chiari, H.: Über Veränderungen des Kleinhirns, Pons und der Medulla oblongata in Folge von congenitaler Hydrocephalie des Großhirns. Denkschr. Kaiserl. Akad. Wiss. Math. Naturw. Classe63, 71–115 (1896)

    Google Scholar 

  • Cleland: Contributions to the study of spina bifida, encephalocele and anencephalus. J. Anat. Physiol.17, 257–292 (1883)

    Google Scholar 

  • Cogan, D. G., Lawrence, J. B.: Platybasia and the Arnold-Chiari malformation. Arch. Ophthal.52, 13–29 (1954)

    Google Scholar 

  • Colclough, J. A.: Stimulation of herniated cervical disc by Arnold-Chiari deformity, presentation of 2 cases. Surgery28, 874–880 (1950)

    Google Scholar 

  • Collier, J.: The false localising signs of intracranial tumour. Brain27, 490–508 (1904)

    Google Scholar 

  • Cossa, P., Duplay, M., Martin, J., Aubert, D., Hemmi, M.: Malformation d'Arnold-Chiari. Impression basilaire, invagination basilaire; platybasie; convexobasie; aplasie de lame basilaire; à propos de deux observations. Rev. neurol.85, 392–398 (1951)

    Google Scholar 

  • Cushing, H.: Some experimental and clinical observations concerning states of increased intracranial tension. Amer. J. med. Sci.124, 375–400 (1902)

    Google Scholar 

  • Custis, D. L., Verbrugghen, A.: Basilar impression resembling cerebellar tumor. Arch. Neurol. Psychiat. (Chic.)52, 412–415 (1944)

    Google Scholar 

  • Earle, K. M., Baldwin, M., Penfield, W.: Incisural sclerosis and temporal lobe seizures produced by hippocampal herniation at birth. Arch. Neurol. Psychiat. (Chic.)69, 27–42 (1953)

    Google Scholar 

  • Epstein, B. S.: Pantopaque myelography in the diagnosis of the Arnold-Chiari malformation without concomitant skeletal or central nervous system defects. Amer. J. Roentgenol.59, 359–364 (1948)

    Google Scholar 

  • Godlewski, St.: Quelques apports récents sur les anomalies congenitales de la charnière cervico-occipitale. Sem. Hôp. Paris48, 1635–1679 (1972)

    Google Scholar 

  • Golding, D. J.: Cerebellar ectopia presenting in adult life. Brit. med. J.1969 II, 119

  • Gordon, D. S.: Neurological syndromes associated with craniovertebral anomalies. Proc. roy. Soc. Med.62, 725–727 (1969)

    Google Scholar 

  • Gustafson, W. A., Oldenberg, E.: Neurological significance of platybasia. Arch. Neurol. Psychiat. (Chic.)44, 1184–1198 (1940)

    Google Scholar 

  • Hankinson, J.: Syringomyelia and the surgeon. In: Modern trends in neurology ed. D. Williams Vol. 5, pp. 127–148. New York: Appleton-Century-Crofts (1970)

    Google Scholar 

  • Hurteau, E. F.: Arnold-Chiari malformation. J. Neurosurg.7, 282–284 (1950)

    Google Scholar 

  • Labsan, H. F., Proctor, L. D.: Syringomyelia associated with Arnold-Chiari malformation. Henry Ford Hosp. Bull.8, 157–162 (1960)

    Google Scholar 

  • Larson, S. J., Sances, A., Baker, J. B., Reigel, D. H.: Herniated cerebellar tonsils and cough syncope. J. Neurosurg.40, 524–528 (1974)

    Google Scholar 

  • List, C. F.: Neurological syndromes accompanying developmental anomalies of occipital bone, atlas, and axis. Arch. Neurol. (Chic.)45, 577–616 (1941)

    Google Scholar 

  • Malis, L. I., Cohen, I., Gross, S. W.: Arnold-Chiari malformation. Arch. Surg.63, 783–798 (1951)

    Google Scholar 

  • McConnell, A. A., Parker, H. L.: Deformity of hind-brain associated with internal hydrocephalus; its relation to Arnold-Chiari malformation. Brain61, 415–429 (1938)

    Google Scholar 

  • McHenry, L. C., Jr., Ewald, R. A., Talbert, W. M., Jr., Elwell, R. H.: Bilateral cortical cerebellar sclerosis. Residuum of cerebellar swelling or displacement early in life. Arch Path.78, 665–672 (1964)

    Google Scholar 

  • Meyer, A.: Herniation of the brain. Arch. Neurol. Psychiat. (Chic.)4, 387–400 (1920)

    Google Scholar 

  • Newton, E. J.: Syringomyelia as a manifestation of defective fourth ventricular drainage. Ann. roy. Coll. Surg.44, 194–213 (1969)

    Google Scholar 

  • Norton, T., Pawl, R. P.: The Arnold-Chiari deformity in elderly patients: Diagnosis and treatment. Neurochirurgia15, 153–159 (1972)

    Google Scholar 

  • Ogryzlo, M. H.: Arnold-Chiari malformation. Arch. Neurol. Psychiat. (Chic.)48, 30–46 (1942)

    Google Scholar 

  • Pryse-Davies, J., Beard, R. W.: A necrospy study of brain swelling in the newborn with special reference to cerebellar herniation. J. Path.109, 51–74 (1973)

    Google Scholar 

  • Ray, B.: Platybasia with involvement of the central nervous system. Ann. Surg.116, 231–250 (1942)

    Google Scholar 

  • Schmidt, H.: Die Einklemmung der Kleinhirntonsillen bei Hirnatrophie und ihre Bedeutung. Wien. Z. Nervenheilk.30, 289–290 (1972)

    Google Scholar 

  • Schuster, P.: The Arnold-Chiari malformation. Dis. nerv. Syst.15, 264–267 (1954)

    Google Scholar 

  • Sirois, J., Belanger, C.: Malformation d'Arnold-Chiari. Laval méd.18, 1033–1041 (1953)

    Google Scholar 

  • Smith, J., Ridley, A.: Cerebellar ectopia presenting in adult life. Brit. med. J.1969I, 353–355

  • Spillane, J. D., Pallis, C., Jones, A. M.: Developmental abnormalities in the region of the foramen magnum. Brain80, 11–48 (1957)

    Google Scholar 

  • Sunder-Plassmann, M., Salah, S., Jellinger, K.: Late death in cases of internal hydrocephalus treated during early childhood. Neuropädiatrie6, 162–175 (1975)

    Google Scholar 

  • Swanson, H. S., Fincher, E. F.: Arnold-Chiari deformity without bony anomalies. J. Neurosurg.6, 314–319 (1949)

    Google Scholar 

  • Teng, P., Papatheodorou, C.: Arnold-Chiari malformation with normal spine and cranium. Arch. Neurol. (Chic.)12, 622–624 (1965)

    Google Scholar 

  • Tobin, W., Sencer, W.: Neurological management of congenital malformations of the brain stem and upper cervical spinal cord. J. Mt Sinai Hosp.30, 503–506 (1963)

    Google Scholar 

  • Trotot, M. R.: Anomalies cranio-vertebrales avec signes bulbaires, étude clinique et radiologique. Rev. neurol.85, 523–527 (1951)

    Google Scholar 

  • Walsh, M. N., Camp, J. D., McCraig, W. K.: Basilar invagination of the skull (so-called platybasia): report of a case with operation. Proc. Mayo Clin.16, 449–452 (1941)

    Google Scholar 

  • Wertheimer, P., Allegre, G.: Trois observations de malformation d'Arnold-Chiari. Rev. neurol.82, 186–190 (1950)

    Google Scholar 

Download references

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Author notes

  1. Reinhard L. Friede

    Present address: Institute of Pathology, University of Zürich, Schmelzbergstr. 12, Ch-8091, Zürich, Switerland

Authors and Affiliations

  1. Institute of Pathology, Case Western Reserve University, Cleveland, Ohio

    Reinhard L. Friede & Uros Roessmann

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  1. Reinhard L. Friede
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  2. Uros Roessmann
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Friede, R.L., Roessmann, U. Chronic tonsillar herniation. Acta Neuropathol 34, 219–235 (1976). https://doi.org/10.1007/BF00688677

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  • DOI: https://doi.org/10.1007/BF00688677

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