Chiari I malformation, worsening headaches Brain:Again seen is cerebellar tonsillar ectopia with approximately 6 mm of inferior herniation of the left cerebellar tonsil through the foramen magnum and mild effacement of the dorsal subarachnoid space at this level. CSF flow sequence demonstrates patent biphasic flow ventrally and diminished posteriorly at the foramen magnum, similar to prior.Again seen are several scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with mild chronic small vessel ischemic changes. No evidence of acute infarct or intracranial hemorrhage. Again seen is a small CSF intensity lesion measuring 16 x 11 mm in the right cerebellopontine angle compatible with an arachnoid cyst and unchanged. There is minimal if any local mass effect associated with this lesion. No other intracranial mass or mass effect. No hydrocephalus. Brain parenchyma is otherwise unremarkable. No abnormal parenchymal or meningeal enhancement. Paranasal sinuses and mastoid air cells are clear. Calvarium and remainder of the extracranial soft tissue structures are unremarkable.Cervical Spine:No abnormal signal in the cervical cord. No abnormal enhancement. Vertebral body heights are maintained. Mild straightening of the cervical spine and mild retrolisthesis of C5 on C6 remain unchanged. Bone marrow signal is benign. Degenerative changes are seen in the cervical spine as described below:C2/3: No significant spinal canal stenosis or neuroforaminal compromise, unchanged.C3/4: No significant spinal canal stenosis or neuroforaminal compromise, unchanged.C4/5: No significant spinal canal stenosis or neuroforaminal compromise, unchanged.C5/6: There is a disc osteophyte complex, mild ligamentum flavum thickening, and bilateral uncovertebral hypertrophy resulting in mild spinal canal stenosis which is stable to minimally worse since prior along for differences in technique and neck position. There is moderate bilateral neural foraminal narrowing which also appears minimally worse since prior.C6/7: Again seen is small disc osteophyte complex, mild uncovertebral hypertrophy, and ligamentum flavum thickening with minimal narrowing of the spinal canal. There is mild right and minimal left neural foraminal stenosis which is not significant changed.C7/T1: No significant spinal canal stenosis or neuroforaminal compromise, unchanged.
1. Compared to 10/28/2013 and 12/28/2012, there is no significant change in ectopia of the cerebellar tonsils with the left cerebellar tonsil measuring up to 6 mm below the foramen magnum. There is is mildly diminished CSF space and CSF flow involving the posterior aspect of the foramen magnum similar to prior.2. Unchanged small right cerebellopontine angle arachnoid cyst with minimal, if any, local mass effect.3. Mild chronic small vessel ischemic changes.4. No cord signal abnormality or evidence of syrinx in the cervical cord. 5. Degenerative changes in the cervical spine at C5-C6 and C6-C7 which are minimally worse since 10/28/2013. Please see details above.