Recent memory changes and numbness and tingling in the upper extremities. Known to have Chiari malformation with syrinx. Annual follow up BRAIN:There is no acute infarct or intracranial hemorrhage. Aside from low lying cerebellar tonsils related to Chiari I malformation which are not appreciably changed, the brain is unremarkable. The ventricles are normal in size as well as the sulci. There is no midline shift. The major intracranial vascular flow voids are preserved. There is trace mucosal thickening in the nasal sinuses. There is no gross orbital abnormality. Prominent pharyngeal tonsils and upper cervical lymph nodes, including nodes of Rouvière, are probably reactive in this age group.The cerebellar tonsils extend up to 8 mm below the level of foramen magnum. There is relative crowding at the level of foramen magnum but without complete obliteration of the CSF space. The CSF flow study, though mildly limited by patient motion, shows preserved, pulsatile ventral CSF flow. However, dorsally the CSF flow is attenuated and delayed.WHOLE SPINE:Cervical spine: Alignment is anatomic. The vertebral bodies are preserved in height. Marrow signal is benign. There is disc desiccation at C5-C6 and C6-C7 associated with very shallow ventral indentations of the thecal sac. Otherwise, there is no significant spinal canal or neural foraminal stenosis in the cervical spine. Also, the cervical spinal cord shows normal signal and morphology. There is no cervical syrinx. Prominent pharyngeal tonsils and upper cervical lymph nodes, as described above, are probably reactive.Thoracic and lumbosacral spine: Alignment is anatomic. Of note, there is partial lumbarization of S1. The vertebral bodies are preserved in height. Marrow signal is benign. The discs show preserved height and T2 signal. The spinal canal and neural foramina are preserved. The central canal remains minimally prominent from mid T6 level through T7-T8 level, axially measuring 1-2 mm at maximum. The spinal cord shows normal morphology and signal. The tip of the conus medullaris lies at T12-L1 level which is normal.
1.Chiari 1 malformation with mildly diminished CSF flow dorsally at the foramen magnum similar to prior. The brain is otherwise unremarkable.2.Persistent mild prominence of the central canal in the mid thoracic spine compared to 2014 although less prominent when compared to 11/17/2012. Spine imaging is otherwise normal. 