History of Chiari decompression, new symptoms, difficulty swallowing and gait changes. Again seen are postsurgical changes of Chiari decompression with occipital craniectomy and cranioplasty. Posterior C1 arch resection is also again seen. The cervical vertebral bodies are appropriate height. Alignment is maintained. Bone marrow signal is within normal limits. There is good ventral and dorsal biphasic CSF flow at the foramen magnum. Again seen is prominence of the retrocerebellar CSF space. Multiple T2 hyperintense lesions are noted in the cervical cord, relatively largest at C2 and C7 levels, with smaller lesions including right C4-C5, left C6, and bilaterally at T1. These appear similar to 1/31/2013 without new lesions identified.Mild degenerative changes are seen as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: No significant compromise to the spinal canal. Minimal left greater than right foraminal narrowing. C4-5: No significant compromise to the spinal canal. Mild left foraminal narrowing related to uncovertebral hypertrophy.C5-6: Prominent disc osteophyte complex and uncovertebral hypertrophy on the left which results in moderate left-sided neural foraminal stenosis. No significant compromise to the spinal canal or right neural foramina.C6-7: Small disc osteophyte complex, eccentric to the left with minimal left neural foraminal narrowing. No significant spinal canal or right foraminal narrowing..C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. Postsurgical changes of Chiari decompression with preserved CSF flow ventrally and dorsally at the foramen magnum.2. Multifocal T2 hyperintense lesions throughout the cervical cord similar to prior from 1/31/2013, which are nonspecific, but most suggestive of chronic demyelinating disease. Other prior inflammatory processes may also be considered. No new lesions are demonstrated to suggest progression. MRI of the brain with contrast can be considered if there is possibility of active demounting disease in the brain.3. Degenerative changes in the cervical spine including left foraminal disc osteophyte complex at the C5-C6 level which results in moderate left-sided foraminal narrowing. No significant spinal canal stenosis at any level.