53 years, Male, increased pain in back of head, dizziness, diplopia. Evaluate Arnold-Chiari malformation.. Brain: Again seen is evidence of Chiari I malformation with ectopic cerebellar tonsils measuring up to 1 cm below the foramen magnum similar to prior. There is crowding with diminished CSF spaces ventrally and dorsally at the foramen magnum. Biphasic CSF flow is present but mildly diminished ventrally and severely diminished dorsally at the foramen magnum.Abnormal T1 hyperintensity involving the neurohypophysis previously described is not well assessed on the current study and can be better assessed on dedicated pituitary MRI if clinically indicated. Remainder of the brain parenchyma appears unremarkable for patient's age. No intracranial mass or mass effect. No evidence of infarct or hemorrhage. There is asymmetric size of the lateral ventricles which can be normal ventricle. No hydrocephalus. No extra-axial collections. Calvarium and extracranial soft tissues are unremarkable.Cervical Spine:No abnormal signal in the cervical cord or evidence of syrinx. Vertebral body heights in the cervical spine. There is mild retrolisthesis of C3 on C4 and C6 on C7. Bone marrow signal is benign. T1 hyperintense lesion involving the T1 bright device consistent with a hemangioma.C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and ligamentum flavum thickening with mild spinal canal stenosis. Minimal right neural foraminal stenosis. No significant left neural foraminal narrowing. C4-5: Minimal central disc protrusion. No significant spinal canal or neural foraminal stenosis.C5-6: Disc osteophyte complex and bilateral uncovertebral hypertrophy. There is no significant spinal canal stenosis. There is moderate right and mild left neural foraminal stenosis.C6-7: Disc osteophyte complex and uncovertebral hypertrophy. There is moderate bilateral neural foraminal stenosis, slightly worse on the right. No significant spinal 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.
1. Findings of Chiari I malformation are similar to prior with tonsillar descent measuring up to 1 cm below the foramen magnum. There is associated diminished CSF spaces and CSF flow at the foramen magnum as described above.2. No evidence of cervical syrinx.3. Degenerative changes in the cervical spine, relatively worse at the C3-C4, C5-C6, and C6-C7 levels as above.