Female, 23 years old, with history of lipomyelomeningocele, Chiari and pseudotumor, evaluate for pathology. Brain:Metallic artifact along the right suboccipital region may represent the presence of a shunt system, new from the prior MRI. Trace T1 hyperintense material adherent along the ependymal surface of the right lateral ventricle, and to a lesser extent in the suprasellar cistern, has become less conspicuous than on prior exams. No evidence of parenchymal edema or mass effect is seen. Diffusion-weighted images are within normal limits. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are small in caliber but within normal limits.Cervical spine:Evidence of suboccipital craniectomy and resection of the posterior arch of C1 is demonstrated. Expansion of the CSF space at the foramen magnum is seen with no evidence of crowding of the cerebellar tonsils or the brainstem. Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No concerning marrow signal abnormality is detected. Assessment of the spinal cord is compromised by motion artifact but no significant abnormalities are suspected.Thoracic spine:A dextroscoliotic curvature of the thoracic spine is noted. In the sagittal plane, the vertebral bodies are well aligned. Vertebral body height and morphology are within normal limits. No concerning marrow replacement or edema is observed. Again, evaluation of the spinal cord is somewhat compromised by motion artifact, but no significant abnormalities are suspected.Lumbar spine:Compensatory scoliotic curvature of the lumbar spine is seen. In the sagittal plane, the vertebral bodies are well aligned. No evidence of marrow replacement or marrow edema is seen. Postoperative findings are redemonstrated compatible with laminectomy from L2 through the sacrum. The spinal cord remains low-lying with the conus continuing down to the L3 level. Below this point, the nerve roots of the cauda equina are closely opposed to the left lateral aspect of the thecal sac suggesting adhesions. Scattered fibrous strands are also noted within the ectatic lower thecal sac which may represent adhesions as well. No significant interval change is observed. On prone imaging, no clear anterior motion of the conus or cauda equina is demonstrated.
1.No acute findings or significant interval changes are noted intracranially.2.Findings are seen compatible with Chiari decompression. The CSF space is expanded at the foramen magnum with no evidence of brainstem or cerebellar tonsil crowding.3.Apart from scoliosis, evaluation of the thoracic spine is unremarkable.4.Redemonstration of postoperative findings in the lumbar spine. The spinal cord remains low-lying and is likely adhesed to the left lateral wall of the thecal sac. No significant interval change is noted.