Patient is a 48-year-old female patient who presents with history of Chiari I decompression in 1998 and a constellation of symptoms including holocephalic pressure-like headache, perioral numbness, tingling and numbness in her fingers and hands bilaterally, weakness in her legs with difficulty walking, and confusion and slow thinking. Brain:Postsurgical changes of suboccipital craniotomy and resection of posterior arch of C1 are noted. CSF spaces at the neo-foramen magnum are preserved. CSF flow study demonstrates preserved biphasic CSF flow through the foramen magnum, greater ventrally than dorsally.There is no evidence of intracranial hemorrhage, mass, or acute infarct. Small cystic lesion along the superior aspect of the right hippocampal head with mild local mass effect likely represents a choroidal fissure cyst. No abnormal parenchymal or meningeal enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. Cervical spine:There is slight loss of cervical lordosis, which may be in part positional. Otherwise the alignment is anatomic. Vertebral body heights and intervertebral disc spaces are preserved. There is no cervical cord abnormality. There appears to be a small disc extrusion at the C5-C6 level, which is suboptimally evaluated due to motion degradation, but results in mild spinal canal stenosis without cord signal abnormality. The remainder of the levels are unremarkable. No abnormal enhancement is noted. No evidence of syrinx. Incidental note is made of subcentimeter thyroid nodules bilaterally.Thoracic spine:Alignment is anatomic. Vertebral body heights and intervertebral disc spaces are preserved. No cord signal abnormalities identified. No significant degenerative changes or spinal canal or neural foraminal stenosis is seen. No evidence of syrinx.
1.Postoperative changes related to Chiari decompression. Foramen magnum is well decompressed with preserved biphasic CSF flow. No evidence of syrinx in the cervical or thoracic cord.2.Right choroidal fissure cyst with mild local mass effect on the hippocampus. This finding is of doubtful clinical significance. 3.Small disc extrusion at C5-6 with mild spinal canal stenosis.