Chiari malformation. Torticollis and gait issues. 6 month follow-up. BRAIN: The cerebellar tonsils again extend up to approximately 21 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 ventrally especially at C1 level which is slightly more pronounced than on the previous examination but this likely relates to different head positions, as the patient's neck is much more flexed on today's examination. Dorsal flow, however, has slightly improved since the prior examination. There continues to be mismatch of synchronicity between ventral and dorsal flow. 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. Stable Chiari type 1 malformation. Compared to previous examination, CSF flow shows increased attenuation of the ventral flow at and below the level of foramen magnum which likely relates to differences in head position as described above. 2. No cervical syringohydromyelia.