Reason: Evaluate for ischemia History: Dizziness, L sided headache and veering to L MRI BRAIN:There is crowding at the foramen magnum with descent of the slightly pointed cerebellar tonsils 8 mm below the foramen magnum, compatible with a Chiari 1 malformation. 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 or herniation. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. Minimal mucosal thickening of an anterior ethmoid air cell, otherwise the sinuses are grossly clear.MRI CERVICAL SPINE:There is mild reversal of the normal cervical lordosis. There is multilevel disc desiccation with mild degenerative disc disease at C5-C6 and C6-C7. There are multilevel degenerative endplate marrow signal. Vertebral body heights are intact. Cerebellar tonsils again extend 8-9 mm below the level of the foramen magnum. There is focal prominence of the central canal within the cord extending from C1-C2 to C2-C3. There is cystic dilatation of the central canal extending from C5-C6 to T2-T3, measuring 4 x 4 mm in maximum dimension, with at least one septation.C2-C3: No significant spinal or neuroforaminal stenosis.C3-C4: No significant spinal or neuroforaminal stenosis.C4-C5: Mild posterior disc osteophyte complex and uncovertebral joint hypertrophy without significant spinal or neural foraminal stenosis.C5-C6: Mild posterior disc osteophyte complex and uncovertebral joint hypertrophy. No significant spinal stenosis. Moderate bilateral neural foraminal stenosis.C6-C7: Mild posterior disc osteophyte complex. No spinal canal stenosis. Moderate bilateral neural foraminal stenosis.C7-T1: No significant spinal or neuroforaminal stenosis.Prominence of the palatine tonsils bilaterally. There is asymmetry of the piriform sinuses, much larger on the right, however the larynx is incompletely evaluated on this exam.
Chiari I malformation with cystic dilatation of the central canal, likely representing syringohydromyelia. Postcontrast images through the cervical spine are recommended to exclude underlying abnormal enhancement. Additionally, while the inferior margin of the syrinx appears to terminate at T2-T3, MR of the remaining cord may be considered to evaluate for additional cord abnormality.2. Moderate bilateral foraminal narrowing due to spondylotic changes at C5-C6 and C6-C7.3. Asymmetric prominence of the palatine tonsils bilaterally which is nonspecific, possibly relating to hypertrophied lymphoid tissue. Correlation direct inspection is recommended.