Clinical, radiological, and genetic similarities between patients with Chiari Type I and Type 0 malformations

Abstract

Object: Although Chiari Type I (CM-I) and Type 0 (CM-0) malformations have been previously characterized clinically and radiologically, there have been no studies focusing on the possible genetic link between these disorders. The goal of this study was to identify families in whom CM-0 and CM-I co-occurred and to further assess the similarities between these disorders.

Methods: Families were ascertained through a proband with CM-I. Detailed family histories were obtained to identify first-degree relatives diagnosed with CM-0. Several criteria were used to exclude individuals with acquired forms of CM-I and/or syringomyelia. Individuals were excluded with syndromic, traumatic, infectious, or tumor-related syringomyelia, as well as CM-I due to a supratentorial mass, hydrocephalus, history of cervical or cranial surgery unrelated to CM-I, or development of symptoms following placement of a lumbar shunt. Medical records and MR images were used to characterize CM-I and CM-0 individuals clinically and radiologically.

Results: Five families were identified in which the CM-I proband had a first-degree relative with CM-0. Further assessment of affected individuals showed similar clinical and radiological features between CM-0 and CM-I individuals, although CM-I patients in general had more severe symptoms and skull base abnormalities than their CM-0 relatives. Overall, both groups showed improvement in symptoms and/or syrinx size following craniocervical decompression surgery.

Conclusions: There is accumulating evidence suggesting that CM-0 and CM-I may be caused by a common underlying developmental mechanism. The data in this study are consistent with this hypothesis, showing similar clinical and radiological features between CM-0 and CM-I individuals, as well as the occurrence of both disorders within families. Familial clustering of CM-0 and CM-I suggests that these disorders may share an underlying genetic basis, although additional epigenetic and/or environmental factors are likely to play an important role in the development of CM-0 versus CM-I.

Fig. 1

Familial clustering of CM-0 and CM-I. Symbols: circle = female; square = male; diagonal line = deceased; fully shaded = CM-I; half-shaded = CM-0; small diamond = miscarriage; angled connecting lines (9509-0001 and 9509-0100) = monozygotic twins.

Fig. 2

Representative sagittal MR images from all 5 CM-0 patients. Note the absence of tonsillar descent and the presence of syringomyelia. The suboptimal quality of the images is a reflection of data acquisition over many years from multiple surgeons and centers. A: 9320-0001. B and C: 9448-1001. D and E: 9453-0001. F and G: 9509-0100. H and I: 9495-0100.

Fig. 3

Representative sagittal MR images from 3 of the patients with CM-I. The suboptimal quality of the images is a reflection of data acquisition over many years from multiple surgeons and centers. A: 9453-1001. B: 9509-0001. C: 9448-0001.