Female, 14 years old, with lumboperitoneal shunt for pseudotumor with syrinx, presenting with new onset weakness and sensory changes in the lower extremities. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. Robust biphasic CSF flow is seen through the foramen magnum.Signal intensity of the bone marrow is unremarkable. No significant abnormalities of the paranasal sinuses are detected.Spine:A spinal cord syrinx is redemonstrated beginning at approximately the C7 level and continuing down to the T3 level. While the craniocaudal extent of the syrinx has not significantly changed, the maximal caliber has increased. The syrinx now measures up to 6 x 6 mm, previously 5 x 4 mm.Apparent mass effect upon the mid thoracic spinal cord is again seen displacing the cord anteriorly without significant interval change. The etiology for this finding is uncertain but may represent the presence of an intradural arachnoid cyst or some other CSF loculation.Cord morphology and signal characteristics are otherwise unremarkable. The conus tip terminates at T12 which is normal. The nerve roots of the cauda equina disperse evenly through the thecal sac. A lumbar peritoneal drain is visualized entering the thecal sac posteriorly at approximately the L3 level.Spinal alignment is anatomic. Vertebral body height and morphology are normal. No concerning marrow replacement or marrow edema is detected.No significant degenerative disk disease is identified. The spinal canal and neural foramina are patent.
1. Unremarkable evaluation of the brain.2. Mild interval increase in the caliber of the low cervical/upper thoracic cord syrinx. The craniocaudal extent of the syrinx is unchanged.3. Stable apparent mass effect upon the mid thoracic cord which displaces the cord anteriorly.