 Brain:MRI better characterizes the cerebellar tonsillar ectopia as extending 7 mm below the level of foramen magnum. Cerebellar tonsillar morphology remains somewhat rounded, although the leftward tonsil appears more pointed than the right. This does efface the posterior CSF space at the level of the cerebellar tonsils.Additionally, there are small foci of T2 hyperintensity primarily in a periventricular white matter distribution, although similar appearing lesions are also present within the right thalamus, left superior cerebellar peduncle, right pontine/brachium pontis border, midline anterior pons, and the right cerebellar hemisphere. These are not associated with mass effect or restricted diffusion.The ventricles and sulci are normal in size. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. Redemonstrated is mucosal thickening and a superimposed air-fluid level in the left maxillary sinus. A minimal amount of mucosal thickening is present within the right maxillary sinus. The remaining paranasal sinuses and mastoid air cells are clear. Cervical spine:There is slight reversal of normal upper cervical curvature. There are no fractures or subluxations. The marrow signal is benign. The visualized paraspinal contents are unremarkable.T2 hyperintense foci are present within the right lateral lingula as well as within the cervical cord at C2, C2/3, C4, an C4/5.C2/3: UnremarkableC3/4: UnremarkableC4/5: UnremarkableC5/6: Mild disc bulge without stenosisC6/7: Mild disc bulge without stenosisC7/T1: UnremarkableThoracic spine:There is a smooth, physiologic thoracic kyphotic curve. The vertebral body heights and disc spaces are maintained. Marrow signal intensity is benign throughout. There are no definite thoracic cord lesions, although images are somewhat degraded by motion.T1/2 demonstrates no significant disc bulge or cord encroachment.T2/3 demonstrates no significant disc bulge or cord encroachment. T3/4 demonstrates no significant disc bulge or cord encroachment. T4/5 demonstrates no significant disc bulge or cord encroachment. T5/6 demonstrates no significant disc bulge or cord encroachment.T6/7 demonstrates no significant disc bulge or cord encroachment. T7/8 demonstrates no significant disc bulge or cord encroachment. T8/9 demonstrates no significant disc bulge or cord encroachment. T9/10 demonstrates no significant disc bulge or cord encroachment.T10/11 demonstrates no significant disc bulge or cord encroachment. T11/12 demonstrates no significant disc bulge or cord encroachment. T12/L1 demonstrates no significant disc bulge or cord encroachment. Lumbar spine:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The visualized intra-abdominal and paraspinal contents are unremarkable.A T2 hyperintense focus is noted within the thoracic cord at the L1 level.L1/2: UnremarkableL2/3: UnremarkableL3/4: UnremarkableL4/5: Disc desiccation, slight disc height loss, and the small left paracentral disc protrusion causing minimal left lateral recess stenosis.L5/S1:There is a small right paracentral/foraminal disc protrusion which abuts and deforms the right S1 nerve root sheath origin.
1.MRI better characterizes the cerebellar tonsillar ectopia as extending 7 mm below the level of foramen magnum. Cerebellar tonsillar morphology remains somewhat rounded, although the leftward tonsil appears more pointed than the right. This does efface the posterior CSF space at the level of the cerebellar tonsils. These findings are consistent with Chiari I malformation.2.There are small foci of T2 hyperintensity primarily in a periventricular white matter distribution, although similar appearing lesions are also present within the right thalamus, left superior cerebellar peduncle, right pontine/brachium pontis border, midline anterior pons, and the right cerebellar hemisphere. These are not associated with mass effect or restricted diffusion. There are also T2 hyperintense lesions within the cervical cord and distal thoracic cord. This constellation of features and locations is most suggestive of a demyelinating process such as multiple sclerosis.3.L4/5: Small left paracentral disc protrusion causing minimal left lateral recess stenosis.4.L5/S1:There is a small right paracentral/foraminal disc protrusion which abuts and deforms the right S1 nerve root sheath origin.5.Redemonstrated is mucosal thickening and a superimposed air-fluid level in the left maxillary sinus. A minimal amount of mucosal thickening is present within the right maxillary sinus.