Arnold-Chiari syndrome without spina bifida or hydrocephalus [Q07.00] / Insomnia, unspecified [G47.00], Reason for Study: ^Reason: Patient has history of chiari, r/o syrinx. PLEASE DO CINE FLOW History: headaches Brain MRINo evidence of acute ischemic or hemorrhagic lesion.There is about 19 mm although not herniation of cerebellar tonsils consistent with Chiari I malformation with evidence of suboccipital craniectomy.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, restricted diffusion/acute ischemia, or abnormal contrast enhancement. Normal flow voids are identified in the major intracranial vessels. The mastoid air cells are clear. Small retention cyst on the right posterior ethmoid sinus.Complete Spine MRIThere is no evidence of syringomyelia.There is normal cervical lordosis. The cranial-cervical junction is normal. There is normal thoracic kyphosis and lumbar lordosis. The spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The cord signal is normal. The conus medullaris terminates at the level of T12-L1.CSF flow study, through the foramen magnum.There is bidirectional CSF flow anterior aspect of upper cervical spine and brain stem through the foramen magnum.Bidirectional flow remained in the posterior aspect of cerebellar hemisphere and tonsil. These findings are unchanged since prior scan.
1. No evidence of acute ischemic or hemorrhagic lesion. No abnormal enhancement. Ventricle size remains normal.2. Unchanged downward displacement of cerebellar tonsil with evidence of suboccipital craniectomy.3. No evidence of syringomyelia.4. Bidirectional CSF flow is demonstrated especially anterior aspect of brainstem and upper cervical spine through the foramen magnum as well as posterior aspect of the cerebellar tonsil and posterior aspect of the cerebellar hemisphere, unchanged since prior scan.