{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T06:25:24Z","timestamp":1787120724588,"version":"build-2736575974"},"reference-count":18,"publisher":"Wiley","issue":"7","license":[{"start":{"date-parts":[[2026,7,3]],"date-time":"2026-07-03T00:00:00Z","timestamp":1783036800000},"content-version":"vor","delay-in-days":2,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Case Reports"],"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>The simultaneous occurrence of Arnold\u2013Chiari Malformation Type II (ACM II), syringomyelia, and an acquired tracheoesophageal fistula (TEF) in a young adult is exceptionally rare and represents a major diagnostic challenge. Arnold\u2013Chiari Malformation II is characterized by the herniation of cerebellar structures through the foramen magnum. It usually presents in infancy in association with myelomeningocele; co\u2010existing TEF and syringomyelia in an adult, as in our patient, is seldom documented. Notably, the present case represents a Chiari II phenotype without spinal dysraphism, lying outside the classic definition that requires an associated myelomeningocele. A 21\u2010year\u2010old male presented with a two\u2010year history of progressive neurological and oropharyngeal symptoms. He also reported nasal regurgitation, cervicogenic vertigo, photophobia, and hoarseness. Neurological examination revealed multidirectional nystagmus, optic atrophy in the right eye, right cerebellar signs, fasciculations, and fundoscopy showed a filled disc and temporal margin blurring in the right eye. MRI of the brain and cervical spine revealed a 10.3\u2009mm herniation of the cerebellar tonsils below the foramen magnum, typical of ACM Type II with syringomyelia. The brain CT scan identified a tracheoesophageal fistula above the carina with a 0.5\u2009cm communication and a diverticulum on the right side of the trachea. Initially, the patient was treated symptomatically with antihistamines, antibiotics, and nasal sprays. The patient was also given multidisciplinary consultation for neurosurgical decompression and underwent posterior fossa decompression surgery, including suboccipital craniectomy and C1 laminectomy, to relieve compression at the foramen magnum and restore cerebrospinal fluid flow. This case underscores an unusual constellation of ACM Type II with extracranial complications and highlights the diagnostic importance of neuroimaging in complex craniospinal presentations.<\/jats:p>","DOI":"10.1002\/ccr3.73023","type":"journal-article","created":{"date-parts":[[2026,7,4]],"date-time":"2026-07-04T05:42:52Z","timestamp":1783143772000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Bulbar \u201cRed Flag\u201d Symptoms and a 21\u2010Year Diagnostic Delay in Adult Arnold\u2013Chiari Type\n                    <scp>II<\/scp>\n                    Malformation With Tracheoesophageal Fistula and Syringomyelia: A Case Report"],"prefix":"10.1002","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0003-6248-5023","authenticated-orcid":false,"given":"Zahabia","family":"Adnan","sequence":"first","affiliation":[{"name":"Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8919-1591","authenticated-orcid":false,"given":"Yashfa","family":"Rajput","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-3763-9808","authenticated-orcid":false,"family":"Chanchan","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-7938-6995","authenticated-orcid":false,"given":"Marium","family":"Fawad","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0008-9861-9907","authenticated-orcid":false,"given":"Muhib Ullah","family":"Azhar","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0007-8614-3924","authenticated-orcid":false,"given":"Abedin","family":"Samadi","sequence":"additional","affiliation":[{"name":"Kabul University of Medical Sciences, Abu Ali Sina  Kabul Afghanistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-2930-8188","authenticated-orcid":false,"given":"Ahmed Asad","family":"Raza","sequence":"additional","affiliation":[{"name":"Jinnah Sindh Medical University  Karachi Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,3]]},"reference":[{"key":"e_1_2_14_2_1","volume-title":"StatPearls","author":"Kuhn J.","year":"2024"},{"key":"e_1_2_14_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/brainsci13121658"},{"key":"e_1_2_14_4_1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm12144626"},{"key":"e_1_2_14_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/ca.22442"},{"key":"e_1_2_14_6_1","doi-asserted-by":"publisher","DOI":"10.1017\/S0317167100036313"},{"key":"e_1_2_14_7_1","doi-asserted-by":"publisher","DOI":"10.3171\/2019.7.SPINE181139"},{"key":"e_1_2_14_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nec.2022.08.007"},{"key":"e_1_2_14_9_1","doi-asserted-by":"publisher","DOI":"10.1227\/00006123\u2010198304000\u201000003"},{"key":"e_1_2_14_10_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10143\u2010010\u20100266\u20103"},{"issue":"3","key":"e_1_2_14_11_1","first-page":"162","article-title":"Acquired nonmalignant tracheoesophageal fistula","volume":"59","author":"Abi Ghanem M.","year":"2011","journal-title":"Le Journal M\u00e9dical Libanais. The Lebanese Medical Journal"},{"key":"e_1_2_14_12_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajmg.a.36324"},{"key":"e_1_2_14_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nec.2022.08.006"},{"key":"e_1_2_14_14_1","doi-asserted-by":"publisher","DOI":"10.1242\/dev.145904"},{"key":"e_1_2_14_15_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nec.2015.06.003"},{"key":"e_1_2_14_16_1","doi-asserted-by":"publisher","DOI":"10.1183\/16000617.0094\u20102020"},{"key":"e_1_2_14_17_1","doi-asserted-by":"publisher","DOI":"10.21037\/jtd.2018.05.200"},{"key":"e_1_2_14_18_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.70109"},{"issue":"2","key":"e_1_2_14_19_1","first-page":"315","article-title":"Clinical Characteristics of Neurogenic Dysphagia in Adult Patients With Chiari Malformation Type I","volume":"49","author":"Yu T.","year":"2017","journal-title":"Beijing Da Xue Xue Bao Yi Xue Ban [Journal of Peking University (Health Sciences)]"}],"container-title":["Clinical Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73023","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/ccr3.73023","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/ccr3.73023","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,19]],"date-time":"2026-08-19T05:33:17Z","timestamp":1787117597000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/ccr3.73023"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":18,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1002\/ccr3.73023"],"URL":"https:\/\/doi.org\/10.1002\/ccr3.73023","archive":["Portico"],"relation":{},"ISSN":["2050-0904","2050-0904"],"issn-type":[{"value":"2050-0904","type":"print"},{"value":"2050-0904","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]},"assertion":[{"value":"2026-01-03","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-16","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-03","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e73023"}}