Diagnosis: Spina bifida with hydrocephalus, unspecified region. Dizziness and giddiness Syncope and collapse Presence of cerebrospinal fluid drainage deviceClinical question: h/o vp shunt, Chiari malformation with falls and dizziness The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post suboccipital craniectomy. The cerebellar tonsils are low lying and pointed. The tips of the tonsils extend to the C1 vertebral level.There is biphasic flow at the level of the foramen magnum on the CSF flow study.A ventriculostomy tube courses through the right frontal lobe into the left lateral ventricle and has its tip in the left basal ganglia. The lateral ventricles are not dilated.There is redemonstration of a T2 hyperintense focus which is low signal on FLAIR and T1-weighted imaging following CSF space on all pulse sequences located in the left thalamus which is stable compared to prior exams.The sella is enlarged and a partially empty. There is a nonenhancing focus present along the left half of the sella against the left cavernous sinus which is unchanged since the prior exam this appearance has been unchanged since the prior exam of 3/21/14 and has been present since exams dating back to 2009 when it was thinner.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate some mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.
1.The lateral ventricles are stable in size compared to prior exams. The patient is status post suboccipital craniotomy and has Chiari I malformation. There is no change in appearance compared to the prior exam. The patient's ventriculostomy shunt catheter is in stable position.2.There is a nonenhancing lesion in the pituitary fossa, eccentric towards the left side significance is uncertain. It has been stable since the prior exam but was thinner in 2009. The possibility this represents some atelectatic pituitary adenoma cannot be excluded. Please correlate with clinical symptoms. Continued follow-up would be appropriate.