Diagnosis: Compression of brain Unspecified visual disturbance LumbagoClinical question: Chiari malformation, vision changes, new symptoms, evaluate for changes/ please do with cSF flow studySigns and Symptoms: Chiari, vision changes, back pain, spine survey MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils are low lying extending approximately 2 or 3 mm below the level of foramen magnum. There is biphasic flow at the level of the foramen magnum. Incidental note is made of partial empty sella.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is some disc desiccation at this level associated with a disc bulge and some narrowing of the neural foramina bilaterally. There is encroachment of the exiting nerve roots within the neural foramina bilaterally at this levelAt C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. There are couple minor disc bulge is present in the thoracic spineLumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is disk dessication present at this level. There is a small disc bulge present at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.There is a disc bulge present at C5-6 associated with some encroachment of the exiting nerve roots within the neural foramina.2.The cerebellar tonsils are low-lying. There is no evidence for ventriculomegaly or syrinx appreciated3.There are mild degenerative changes present in the thoracic and lumbar spine.