Clinical question: Chiari, tethered cord, new symptoms, please do be CSF flow study and tethered cord protocol. Signs and symptoms: Headache and back pain. Nonenhanced lumbar MRI:Comparison of lumbar sagittal T2 weighted images in supine and prone position demonstrate noticeable anterior movement of the lower thoracic cord and conus and proximal cauda equina.There is a moderately expansile syrinx of the lower most visualized thoracic cord and conus (from T10 inferiorly) and without appreciable change since prior study. There is no detectable signal abnormality of the cauda equina. There is termination of the cord at lower L1 level.There is normal signal intensity, anatomical morphology and the alignment of the vertebral column. No evidence of a spinal canal or neural foraminal compromise. Unremarkable paraspinal soft tissues.Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates expected postoperative changes of Chiari decompression with resultant expansion of the subarachnoid space.There is normal anatomical development of the brain and with normal signal intensity on all MRI sequences otherwise.Unremarkable CT cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.CSF flow study:The inferior pole of the cerebellar tonsil demonstrate a pointed deformity projecting inferiorly and inseparable from the dura at the surgical site which is best appreciated on sagittal T1 weighted images as well as 3-D fiesta sequence. This finding is highly suspected for a focus of adhesion.There is no detectable abnormality at the level of the quadrigeminal plate and the aqueduct.CSF flow study demonstrate presence biphasic flow anteriorly through the foramen magnum without evidence of compromise. The biphasic pulsation of CSF posterior to the cord appears to abruptly terminate at the level of cerebellar tonsils and without detectable flow posterior to the tonsils. Very subtle fro through the inferior fourth ventricle is dictated.
1.Nonenhanced MRI of the lumbar spine demonstrate noticeable anterior movement of the lower thoracic cord, conus and proximal cauda equina on prone sagittal T2 weighted images compared to supine series. No tethered cord. There is termination of cord at lower L1 level. No detectable signal abnormality of the cauda equina. Lower most visualized thoracic cord from T10 inferiorly demonstrate moderately expansile syrinx without interval change since prior study.2.Nonenhanced MRI of brain demonstrate post operative changes of Chiari decompression with expected expansion of subarachnoid space as detailed. Unremarkable intracranial content otherwise. There is pointed deformity of the inferior pole of the cerebellar tonsil projecting inferiorly and inseparable from the surgical site which is suspected for adhesion. CSF flow study demonstrate presence of biphasic flow anteriorly through the foramen magnum. The biphasic pulsation of CSF posteriorly terminates at the level of cerebellar tonsils. Subtle biphasic flow in the inferior aspect of the fourth ventricle is detected.