47 years, Female, worsening headaches, evaluate for Chiari malformation.. Again seen is caudal descent of the cerebellar tonsils, which measure 7 to 8 mm below the foramen magnum and similar to prior study from 6/2/2015. There is some loss of normal rounded contour of the cerebellar tonsils. There is crowding of the CSF spaces and diminished biphasic CSF flow ventrally and dorsally at the foramen magnum. Unchanged nonspecific punctate focus of T2/FLAIR hyperintensity in the left frontal lobe white matter. Unchanged T2/FLAIR hyperintensity in the left aspect of the pons. Unchanged subtle T2/FLAIR hyperintensity involving the globi pallidi. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass. No midline shift or uncal herniation. The ventricles are within normal limits in size and configuration. Again noted is a partially empty sella, similar to prior, with mild deformity of the pituitary gland. Major flow-voids are preserved. There is opacification of the right sphenoid sinus as before. Orbits, calvarium, and remainder of the extracranial soft tissue structures are grossly unremarkable.
1. Findings consistent with Chiari 1 and similar to prior study from 6/2/2015. There is diminished biphasic CSF flow at the foramen magnum.2. Partially empty sella with mild deformity of the pituitary gland. This finding may be postsurgical given reported history of pituitary tumor resection, but would suggest correlation with clinical findings for possibility of pseudotumor cerebri.3. Unchanged nonspecific focus of T2/FLAIR hyperintensity in the left aspect of the pons. There is also subtle T2/FLAIR hyperintensity in the bilateral globi pallidi which is also unchanged since 7/23/2014. These findings are nonspecific but may be related to remote toxic-metabolic injury.4. Chronic opacification of the right sphenoid sinus. 