Clinical question: Chiari malformation, syrinx, pseudotumor cerebri, evaluate for 6 months follow-up. Signs and symptoms: 6 months follow-up. Nonenhanced brain MRI:There is no evidence of an acute intracranial process and no convincing evidence of any new findings since prior exam.Stable postoperative changes of suboccipital craniectomy for Chiari decompression with resultant expansion of subarachnoid space. There is posterior tenting of the cervical medullary junction of the cord similar to prior exam and highly suspected of adhesion to the surgical site. Small focus of FLAIR hyperintensity in the right paramedian inferior cerebellum consistent with a small focus of encephalomalacia demonstrate no significant change. The fourth ventricle is mildly prominent however stable since prior exam.Stable well-demarcated focus of mixed signal abnormality involving the left aspect of clivus and left petrous apex since multiple prior exams and including prior head CT from 5-20 5-2011 and likely representing a focus of fibrous dysplasia.Unremarkable nonenhanced brain MRI otherwise.Nonenhanced cervical MRI:Examination redemonstrate postoperative changes of Chiari decompression as detailed above. There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord and without evidence of syrinx.There is a small central and right para median disc protrusion at C5-C6 with resultant flattening deformity of the ventral aspect of the cord and mild central spinal stenosis. There is slight interval progression of disease since prior study. Patent bilateral neural foraminal.C6/C7 also demonstrate shallow central disc protrusion with trace flattening of the cord and no central spinal stenosis. No significant change since prior exam.CSF flow study at the level of foramen magnum demonstrate presence of biphasic flow anteriorly through the foramen magnum and without detectable flow posteriorly similar to prior exam.
1.Stable post operative changes of Chiari decompression. Posterior tenting of cervical medullary junction of the cord as result of adhesion at the surgical site without change. Stable small focus of encephalomalacia of right inferior paramedian cerebellum and unremarkable exam otherwise.2.MRI of cervical spine demonstrate no evidence of syrinx. Disc protrusion at C5-C6 with interval progression and results in mild central spinal stenosis is noted. A small central disc protrusion at C6/C7 remains stable. Stable focus of fibrous dysplasia involving the left skull base since multiple prior studies.3.CSF flow study demonstrates normal appearing high phasic flow anteriorly through the foramen magnum and absence of flow posteriorly. No detectable flow through the fourth ventricle or the aqueduct.