Assessment of Chiari 1 malformation. MRI Brain:There is left tonsilar herniation extending 1 cm below the level of the foramen magnum. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles are mildly enlarged and the posterior horn of the right lateral ventricle is mildly ectatic compared to the left. The fourth ventricle is patent without evidence of obstruction. The basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Incidental note is made of some fluid within the right mastoid air cells.MRI C-Spine:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. There is no evidence of a syrinx.Degenerative changes are seen in the cervical spine as described below:C2-3: Left greater than right disc osteophyte complex with mild left neuroforaminal stenosis. No right neuroforaminal or central spinal canal stenosis.C3-4: Disc osteophyte complex is noted with mild bilateral neuroforaminal stenosis and mild central spinal canal stenosis.C4-5: Disc osteophyte complex is seen with uncovertebral hypertrophy causing mild central spinal canal stenosis but no neuroforaminal stenosis.C5-6: A right greater than left disc osteophyte complex and uncovertebral hypertrophy with mild central canal stenosis, moderate to severe right neuroforaminal stenosis and mild left neuroforaminal stenosis.C6-7: Left greater than right disc osteophyte complex with moderate uncovertebral hypertrophy causing mild right and moderate left neuroforaminal stenosis. No central canal stenosis.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.MRI T-Spine:The thoracic spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal. There is no evidence of a syrinx.Ligamentum flavum and facet hypertrophy involving the T6/7-T9/10 levels but no neuroforaminal narrowing or central spinal canal stenosis. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the remaining thoracic spine.
1.Left tonsillar herniation 1 cm below the foramen magnum compatible with Chiari I malformation.2.No evidence of a syrinx within the cervical or thoracic cord.3.Multilevel degenerative changes of the cervical spine which causes at most mild central spinal canal stenosis at multiple levels and moderate to severe right neural foraminal stenosis at the C5-6 level.