Female, 4 years old, with neck pain, headaches and sleep issues. Evaluate for Chiari malformation. The cerebellar tonsils are markedly elongated and peglike in shape and they descend up to 18 mm below the level of the foramen magnum. On conventional images, there is significant crowding through the foramen magnum. On CSF flow imaging, attenuation of flow is demonstrated ventrally through the foramen magnum as well as dorsally at the level of the mid cervical spine. Apparent flow related signal overlaying the cerebellar tonsils probably relates to tonsillar motion rather than CSF flow.No evidence of restricted diffusion is seen. No edema or mass effect is detected. Brain parenchymal morphology and signal characteristics are otherwise within normal limits. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. Ventricular size and morphology are within normal limits.Ill-defined T2 hyperintensity is seen within the spinal cord at the C2-3 level. More inferiorly, dilatation of the central canal of the spinal cord is demonstrated at C6-7.Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The intervertebral discs are preserved and there is no compromise of the spinal canal or neural foramina.
1.Findings are seen compatible with Chiari I malformation. The CSF space at the level of the foramen magnum is markedly crowded. The remainder of the brain is within normal limits.2.Ill-defined T2 signal abnormality within the spinal cord at the C2-3 level may represent edema or syrinx formation. More discrete prominence of the central canal of the spinal cord is also seen at C6-7. The remainder of the spinal evaluation is within normal limits.