Female, 34 years old, with bilateral upper extremity weakness and dysphagia, evaluate for central lesion. Brain:Again noted is severe crowding of the foramen magnum, suprasellar cistern, and perimesencephalic cistern, unchanged. Artifact secondary to right frontal approach ventriculostomy catheter limits evaluation of adjacent structures. Ventriculostomy catheter tip is located at the level of the right foramen of Monro. No abnormal enhancement is noted intracranially. Overall the size of the ventricles appears similar to prior CT from 12/1/2016.Fluid intensity is noted in bilateral mastoid air cells and middle ears. Bilateral prior glands demonstrate a nodular appearance.Cervical spine:Again noted is diffuse central T2 hyperintensity is seen within the visualized cervical spinal cord beginning at the C2 level, with a more focal area of abnormal signal intensity at the C2-C3 level, extending beyond the field of view inferiorly but grossly appearing similar to prior exam. The signal changes appear to be predominantly in the gray matter of the spinal cord. The cord is expanded diffusely. No significant enhancement is associated with the signal abnormalities.As noted on prior examinations, the posterior fossa is crowded with a tapered appearance of the cerebellar tonsils which appear to herniate below the foramen magnum, demonstrating 20 mm of caudal extension of pointed cerebellar tonsils beyond the foramen magnum.Straightening of the cervical lordosis is likely positional. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or edema is seen. There is only minimal disc degeneration is seen which causes no significant spinal canal or foraminal stenosis.Note is made of prominence of soft tissues along the pharynx, with narrowing of the airway, likely due to reactive lymphoid tissue.
1.Crowding of foramen magnum and basal cisterns, similar to prior exam and with no abnormal intracranial enhancement or mass.2.Diffuse abnormal signal affects the central portion of the spinal cord beginning at C2 and continuing throughout the remainder of the visualized spinal cord which is expanded, grossly appearing similar to prior exam. The differential diagnosis remains broad and would include infectious, postinfectious or autoimmune phenomena, or related to altered CSF dynamics in the context of Chiari I malformation.