Theodor Langhans described the Chiari I malformation in 1881

Dr. Theodor Langhans, Professor and Chair of Pathological Anatomy in University of Bern, Switzerland.

Dr. Theodor Langhans, Professor and Chair of Pathological Anatomy in University of Bern, Switzerland.

Hans Chiari is appropriately recognized for describing and categorizing the Chiari malformations in reports published in 1891 and 1895. While others such as Jean Cruveilhier (1798-1874) and John Cleland (1835-1925) also made observations prior to Chiari, in an article published in the Journal of Neurosurgery: Pediatrics in March 2011 Martin M. Mortazavi and colleagues propose Theodor Langhans, the German pathologist remembered for describing “Langhans cells” in tuberculosis, as the first to describe the Chiari I malformation.

Mortazavi et al. review Theodor Langhans’ distinguished background:

“Theodor Langhans was born September 28, 1839, in Usingen (Nassau), Germany, and studied under Henle in Göttingen and von Recklinghausen in Berlin. He attended medical school in Heidelberg and, in 1864, completed his medical degree thesis on the structure of tendons in Würzburg. He was also a student under such names as Virchow, Trauber, and Frerichs. He served as assistant to von Recklinghausen until 1867. In Marburg, he collaborated with Lieberkölin and Wagner on anatomical research. He was later made Professor Ordinarius in Giessen and then moved to Switzerland in 1872 where he was appointed Professor and Chair of Pathological Anatomy in Bern, succeeding Klebs.”

In 1881, Langhans described a case of syringomyelia and “pyramidal tumors” of the cerebellum in the publication Über Höhlenbildung im Rückenmark als Folge Blutstauung. Mortazavi et al. translated the report (“Regarding cavity creation in the spinal cord as a consequence of obstruction to blood flow”) and believe “these were the first descriptions of what would become known as the Chiari I malformation described by Langhans as ‘pyramidal tumors.’” These selected passages are key to the description and reveal Langhans awareness of the anatomy and pathophysiology of CMI:

“In the case, which first brought to my attention the necessity to look for cavity formation in the spinal cord following a change in the cerebellar cavity, I could not find a cause for the increase in pressure; but great pressure on the pons and medulla oblongata from above was indeed apparent. Upon dissection of the cerebellum, nothing was of note except for an obvious/significant development of both tonsils, which protruded down in the form of two symmetrical pyramidal tumors and pushed the medulla oblongata in a frontal direction at almost a right angle.” (emphasis added)
“The increase in pressure in the cerebellar cavity will hinder or greatly impede the outflow of blood and cerebral spinal fluid.” (emphasis added)

Mortazavi and colleagues recognize Langhans' contribution and conclude:

“Although the association of Chiari I malformation and syringomyelia would not be commonly used until the late 20th century, it was Langhans in the 19th century who proposed this cause and effect. Therefore, appropriate recognition for this association should be given to this early pioneer who, with Chiari, helped provide us with details of hindbrain herniation that are still in use today.” 

John Oró, MD

 

Reference

The first description of Chiari I malformation with intuitive correlation between tonsillar ectopia and syringomyelia: Historical vignette

Martin M. Mortazavi, M.D., R. Shane Tubbs, M.S., P.A.-C., Ph.D., Maja Andrea Brockerhoff, M.A., Marios Loukas, M.D., Ph.D., and W. Jerry Oakes, M.D.