Clinical question: Chiari decompression several years ago, syrinx, no follow-up since 2010. Patient with new symptoms, evaluate for change, performed CSF flow study. Signs and symptoms: Headache, neck and middle back pain. Nonenhanced brain MRI: Negative diffusion weighted series.Examination demonstrates stable post operative changes of Chiari decompression. There is expansion of subarachnoid space at the surgical site however there is inferior sagging of the cerebellar into the expanded subarachnoid space which remains identical to prior study from 2010.The anatomical morphology of the brain is otherwise within normal limits and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain margination. No evidence of any new finding since prior exam.Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical spine MRI:Stable expected postoperative changes Chiari decompression since prior exam. Mild dorsiflexion of the dens is again noted. Normal signal intensity and caliber of the cervical cord without evidence of syrinx. Normal signal intensity and alignment the vertebral column without spinal canal or neural foraminal compromise at any level. Unremarkable perispinal soft tissues. CSF flow study demonstrate presence of biphasic flow through the foramen magnum both anteriorly and posteriorly. There is also detectable biphasic flow through the fourth ventricle and the aqueduct.Nonenhanced thoracic spine MRI:The signal intensity in the alignment the vertebral column is unremarkable.The signal intensity and caliber of thoracic cord is unremarkable.There is no evidence of spinal canal or neural foraminal compromise at any level.There is termination of the cord at mid L1 level.Nonenhanced lumbar MRI:There is normal anatomical development, signal intensity and alignment of vertebral column.There is normal signal intensity and morphology of cauda equina.There is no detectable perispinal soft tissue abnormalities.
1.Nonenhanced brain MRI demonstrate no evidence of new finding since prior exam. Stable postoperative changes of Chiari decompression as detailed. Unremarkable brain MRI otherwise.2.Unremarkable nonenhanced MRI of the cervical, thoracic and lumbosacral spine as detailed. 3.CSF flow study demonstrate presence of biphasic flow through the foramen magnum anteriorly and posteriorly as well as the fourth ventricle and the aqueduct.