Clinical question: Chiari malformation, pseudotumor C, shunt, worsening symptoms, please check CSF flow and evaluate for syrinx. Signs and symptoms: Headache, vomiting, neck pain worsening. Nonenhanced brain MRI:Expected postoperative changes of Chiari decompression with resultant expansion of subarachnoid space at the level of foramen magnum remain similar to prior exam. There is a catheter/stent extends from the fourth ventricle into the subarachnoid space posteriorly similar to prior exam. There is mild posterior tenting of the cervical medullary junction of the cord similar to prior exam and suspected of adhesion.Negative diffusion-weighted images.Examination demonstrates normal anatomical morphology of the brain otherwise and with normal signal intensity on all MRI sequences. There is no evidence of ventriculomegaly which is a similar observation is prior study. The cortical sulci remain widely patent similar to prior exam.The signal void of major intracranial arterial branches are identified.Unremarkable signal intensity of paranasal sinuses, mastoid air cells and middle ear cavities and unremarkable images through the orbits.Nonenhanced cervical MRI:Examination redemonstrate stable suboccipital Chiari decompression.There is normal signal intensity and caliber of cervical cord without evidence of syrinx.There is normal signal intensity and alignment of the vertebral column.There is no spinal canal or neural foraminal compromise at any level.CSF flow study demonstrate presence of biphasic flow through the foramen magnum both anteriorly and posteriorly without significant change since prior exam.Nonenhanced thoracic MRI:There is normal anatomical development, signal intensity and alignment of vertebral column.There is normal signal intensity and caliber of thoracic cord and in particular without evidence of syrinx.No spinal canal or neural foraminal compromise at any level.No detectable paraspinal soft tissue abnormalities.
1.Nonenhanced MRI of brain demonstrate no acute or new finding since prior study. Stable postoperative changes of suboccipital Chiari decompression and unremarkable MRI exam otherwise.2.CSF flow study demonstrates presence of biphasic flow through the foramen magnum both anteriorly and posteriorly which remains stable since prior exam.3.Unremarkable nonenhanced cervical MRI other than expected Chiari decompression postop changes.4.Unremarkable nonenhanced MRI of thoracic spine and in particular no evidence of syrinx is detected.