Chiari malformations The Chiari malformations (IIV) are a group of disorders involving mainly the posterior fossa.

Chiari type I malformation is the most common cerebellar abnormality identified on MRI. It may not be related to the other two, however, Types II and III are likely related to each other. Chiari type IV malformation is a severe cerebellar hypoplasia without displacement of brain through the foramen magnum. Although Chiari described type IV malformation, it is likely not a distinct entity and probably represents a variation of cerebellar hypoplasia. The normal position of the cerebellar tonsils varies according to the age of the patient. In a newborn the cerebellar tonsils locate slightly inferiorly to the foramen magnum. In adults the tonsils usually locate about the foramen magnum. Cerebellar tonsils that located <3mm below the foramen magnum may be considered normal and this can be called benign tonsillar ectopia. Tonsils that are 36mm below the foramen magnum are indeterminate and their significance needs to be correlated with a clinical symptomatology. Tonsils more than 6mm below the foramen magnum are considered definitely abnormal and compatible with Chiari type I malformation. They are usually pointed (peg-like) rather than rounded with vertically oriented sulci. The Chiari I malformation is more common in females. The symptoms include headaches, neck pain, and progressive ataxia and gait abnormalities. Some patients have hydrocephalus. Dilatation of the central spinal canal (hydromyelia) is found in 2080% of patients. The foramen magnum looks crowdedwith small/absent CSF spaces.