Chiari with cord/medullary compression MRI brain:There is redemonstration of Chiari I malformation with a small posterior fossa and inferiorly pointed cerebellar tonsils. The inferior tip of the cerebellar tonsils is at the level of the C1 vertebra.The sulci and lateral ventricles are relatively small. There is diffuse pachymeningeal meningeal enhancement present which was also present to some degree on the previous exam.No foci of diffusion restriction are appreciated.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are opacified to a large degree.. The visualized portions of the mastoid air cells and middle ears are opacified. The patient is status post intubation. The visualized portions of the orbits are intact.MRI cervical spine:The patient was positioned poorly in the magnet.Since the prior exam the signal hyperintensity centrally within the cervical spinal cord has receded but not resolved. There is redemonstration of a small syrinx at the C3 vertebral body level. There is redemonstration of Chiari I malformation.There is redemonstration of diffuse and predominantly ventral epidural thickening and enhancement suspected to represent epidural venous plexus. This is associated with effacement of the CSF space surrounding the spinal cord from C1-2 down to C4-5. In general this has not changed substantially since the prior exam.The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine or cord.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:There is accumulation of a collection behind and around the cord which is high signal on T1 and T2 but heterogeneous signal on T2 STIR throughout the thoracic spine but predominantly along the upper thoracic spine. In general there is lower signal within this collection on the T2 STIR images on the current exam compared to the prior exam. This is associated with the diffuse heterogeneous enhancement. There is effacement of spinal fluid ventral and posterior to the spinal cord especially at the T3 vertebral body level. The previously noted abnormal signal within the spinal cord centrally from the cervical cord down to T8 level has significantly regressed.The thoracic vertebral bodies are appropriate in the overall alignment and height. There are bilateral pleural effusions. Pulmonary opacities have significantly regressed. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are appreciated in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.Since the prior exam enlargement of the renal pelves and ureter has resolved.
1.Suspect combination of epidural lipomatosis and fluid centered at T3-5 associated with compression of the thecal sac.2.Suspect epidural venous engorgement centered at C2-4 associated with compression of the thecal sac.3.Since the prior exam central cord signal abnormality (C3-T8) has regressed but not resolved. 4.Focal syrinx at C3 is unchanged.5.Chiari I malformation6.Mild pachymeningeal thickening. This is nonspecific. It could relate to low CSF pressure or be reactive to recent lumbar puncture.7.Bilateral pulmonary opacities with pleural effusions. Please correlate with chest x-ray findings.