Chiari malformation, torticollis, and worsening head tilt with shoulder involvement. Brain: The cerebellar tonsils extend up to approximately 20 mm inferior to the foramen magnum and display a pointed configuration with crowding of the foramen magnum in association with a relatively small posterior fossa. There is mildly narrowed column of cerebrospinal fluid flow across the foramen magnum anteriorly, but lack of flow posteriorly. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The orbits are grossly unremarkable. There is scattered paranasal sinus mucosal thickening.Cervical Spine: There is mild retroflexion of the dens. The cervical vertebral column is otherwise unremarkable, without evidence of subluxation. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. The spinal cord displays normal signal and morphology. The paravertebral soft tissues are unremarkable.
1. Chiari type 1 malformation.2. No evidence of syringohydromyelia.