Clinical question: History of hydrocephalus with shunt with progressive lower extremity weakness, syrinx, evaluate for change. Signs and symptoms: Six-month follow-up of syrinx. Pre- and post enhanced cervical MRI:There are no prior exams for comparison.Examination demonstrates stable postoperative changes of Chiari decompression. Similar to prior exam dated is no significant expansion of thecal sac and there is highly suspected posterior adhesion of the dorsal aspect of the cervicomedullary junction of the cord to the surgical site. There is partial visualization of severely dilated fourth ventricle measuring maximum of 21 mm in AP axis compared to prior brain MRI examination (10-17-14) measurement of 25 mm. There is a catheter/stent lying along the dorsal aspect of enlarged fourth ventricle and the tip abutting the dorsal aspect of thecal sac without significant change since prior exam.Examination demonstrates a mildly expansile syrinx of cervical cord extending from the cervicomedullary junction of the cord inferiorly through the entire cervical cord and extending into the thoracic cord. There are no prior MRI of cervical spine for comparison. These findings however on sagittal T1-weighted images of brain MRI from above the demonstrated interval decreased caliber and with resultant better visualization of subarachnoid space in the upper cervical spine. The largest transaxial dimension of syrinx is at the upper cervical spine and measures approximately 6.5 x 7.5 mm. The syrinx at C7 measures at 5.5 x 4.5 mm. + There is no abnormal enhancement of the cord or the left middle meningeal.At C4-C5 there is a small central disc protrusion which effaces the ventral subarachnoid space and applied a subtle mass effect on the cord and mild central spinal stenosis. There is also moderate left and mild right neural foraminal compromise at this level. Degenerative changes at C6-C7 with uncovertebral hypertrophic changes (right greater than left) results in moderate to severe right neural foraminal compromise.There is slight wasting at the C5-C6 disc level (sagittal T2 STIR image 10) which may indicate a congenital incomplete fusion at this level and with resultant exaggerated degenerative changes immediately superior and inferior to this level as detailed.Pre and post enhanced thoracic MRI:There are no prior MRI of thoracic spine for comparison.There is normal signal intensity and anatomical alignment of vertebral column and without evidence of abnormal enhancement.There is a syrinx involving the entire length of the thoracic cord. The cervix measures at 4.3 x 2.8 at T1 level, slit like and measuring 5 x 0.8 mm at T7, slit like and measuring at 4.7 x 2 mm at T9, 5.5 x 2.4 mm at T10 level and 5.5 x 3.5 mm at L1 level. There is no evidence of abnormal enhancement of the cord or the leptomeninges.Pre and post enhanced lumbar MRI:There is termination of the cord at L2-L3 disc level similar to prior exam. There is a mildly expansile syrinx of the lower thoracic cord measuring 5.5 x 6.5 mm at L1 level which is minimally larger since prior study. The signal intensity of the cauda equina is within normal and without detectable abnormal enhancement.There is normal signal intensity and the alignment of vertebral column without abnormal enhancement.
1.Pre- and post enhanced MRI of cervical spine demonstrate stable postoperative changes of aortic decompression as detailed. Revisualization of dilated fourth ventricle with interval decrease in size when compared with prior brain MRI exam from 10-17-14. There is syrinx extending the entire length of cervical cord which demonstrate interval decreased caliber when compared with prior sagittal T1-weighted brain MRI from 10-17-14. There is degenerative changes at C4-C5 and including a central disc protrusion with resultant central spinal stenosis and at C6-C7 level with resultant significant neural foraminal compromise as detailed. Mild wasting at C5-C6 disc level suggestive of congenital incomplete fusion and with presumed accelerated degenerative changes at the levels immediately above and inferior to this level. No abnormal enhancement.2.Pre- and post enhanced MRI of thoracic spine demonstrate a syrinx extending the entire length of thoracic cord as detailed/measured above. There are no prior thoracic MRI images for comparison however when compared with prior lumbar MRI study (10-17-14) the lowermost extent of syrinx of the thoracic cord demonstrate no significant change in size or extend. No abnormal enhancement of the vertebral column, thoracic cord or the leptomeninges.3.MRI of lumbar spine demonstrate termination of the cord at L2-L3 disc level similar to prior study. Normal signal intensity of cauda equina and without abnormal enhancement. Normal signal intensity and alignment of vertebral column and without abnormal enhancement.