T2 weighted sagittal MR shows a Chiari I malformation with tonsillar ectopia (9 mm) at the cranio–cervical junction, resulting in disruption of normal pulsatile flow of CSF and the development of an extensive syrinx. T2 weighted sagittal MR shows a Chiari I malformation with tonsillar ectopia (9 mm) at the cranio–cervical junction, resulting in disruption of normal pulsatile flow of CSF and the development of an extensive syrinx. I Bone, and D M Hadley J Neurol Neurosurg Psychiatry 2005;76:iii29-iii38 ©2005 by BMJ Publishing Group Ltd