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Clinical Neurology · Child Neurology

Congenital Brain Malformations

Congenital malformations of the brain.

MalformationDescription
LissencephalyAbsence of sulci — "smooth brain"
PachygyriaFew broad, thick gyri — "incomplete lissencephaly" (pachy = thick)
PolymicrogyriaNumerous small gyri
SchizencephalyCleft lined with grey matter connecting ventricle to pial surface; open-lip or closed-lip
PorencephalyCleft or cyst in the hemisphere, not lined with grey matter — "encephalomalacia"
HydranencephalyCerebral hemispheres absent, replaced by CSF
HoloprosencephalyForebrain fails to divide into two hemispheres.
  • Alobar: severe form, hemispheres fail to separate resulting in cyclopia
  • Semilobar: incomplete separation, may lead normal life
  • Lobar: interhemispheric fissure complete, thalami separated but fornices fused, frontal horns of lateral ventricle fused, septum pellucidum absent
AnencephalyAbsence of the brain, skull, and scalp
EncephaloceleSac-like protrusion of brain and meninges
Septo-optic dysplasia (De Morsier)2 of the following: absence of septum pellucidum, pituitary gland, and optic nerves. Can be caused by in-utero valproate exposure
Dandy-Walker Syndrome
DW malformationMost severe form, consists of:
  • Absence of cerebellar vermis
  • Large posterior fossa with high tentorium
  • Cystic dilatation of 4th ventricle
DW variantMild form with hypoplastic vermis, mildly enlarged 4th ventricle
Chiari Syndrome
Chiari IDisplacement of peg-like cerebellar tonsils through foramen magnum >5 mm
Chiari II (Arnold-Chiari)Displacement of medulla, 4th ventricle, and vermis through foramen magnum; usually associated with peaked tectum and lumbar myelomeningocele
Chiari IIISimilar to Chiari II with occipital encephalocele
Chiari IV (obsolete)Cerebellar hypoplasia (now called primary cerebellar agenesis)

LIGHTS on RITE by Ahmed Koriesh