62 year-old female with Chiari I, vertigo, worsening disequilibrium. Motion degrades a few sequences. Given this caveat:Redemonstrated is crowding at the level of the foramen magnum. As before, the tonsils lie 4 mm below the foramen magnum, within the upper limits of normal range. There is some minimal, persistent pointed morphology of the left cerebellar tonsil. The right cerebellar tonsil is normally rounded in morphology. CSF flow analysis demonstrates biphasic flow posteriorly at the level of the foramen magnum and cerebellar tonsillar tips.There is a subtle 2-3 mm focus of abnormality within the posterior inferior pituitary which is slightly hyperintense on T1, minimally hyperintense on T2, demonstrating relative hypoenhancement. This appears more prominent than the comparison, where it was extremely subtle. However, technique differences on the current study due to the added IAC sequences make it more conspicuous.There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma signal appears unremarkable. There are no areas of abnormal contrast enhancement. The ventricles and basal cisterns are otherwise normal in size and configuration. The skull and extracranial soft tissues are unremarkable. Suprasellar cistern is diminutive in size.Images of the internal auditory canals demonstrate the seventh and eighth nerves to be normal in size and symmetric bilaterally without masses or enhancing lesions along the course of these nerves or in the cerebellopontine angle cisterns bilaterally. The inner ear structures are normal in appearance and symmetric bilaterally without congenital inner ear anomalies identified on either side. There is stable mild mucosal thickening in the right maxillary sinus. There is fluid opacification of right mastoid air cells which is nonspecific and unchanged.
1.Redemonstrated is crowding at the level of the foramen magnum. As before, the tonsils lie 4 mm below the foramen magnum, within the upper limits of normal range. There is some minimal, persistent pointed morphology of the left cerebellar tonsil. The right cerebellar tonsil is normally rounded in morphology. CSF flow analysis demonstrates biphasic flow posteriorly at the level of the foramen magnum and cerebellar tonsillar tips.2.There is a subtle 2-3 mm focus of abnormality within the posterior inferior pituitary which is slightly hyperintense on T1, minimally hyperintense on T2, demonstrating relative hypoenhancement. This appears more prominent than the comparison, where it was extremely subtle. However, technique differences on the current study due to the added IAC sequences make it more conspicuous. The differential diagnosis would include a microadenoma or complicated cystic lesion. Recommend dedicated pituitary MRI imaging with contrast for complete characterization.3.There is fluid opacification of right mastoid air cells which is nonspecific and unchanged.4.Negative MRI of the internal auditory canals.