Diagnosis: Benign intracranial hypertension Arnold-Chiari syndrome without spina bifida or hydrocephalus. Other disorders of meninges, not elsewhere classifiedClinical question: Chiari malformation, 4th ventricle stent, pseudomeningocele, please do with CSF flow studySigns and Symptoms: headaches, neck pain MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The patient is status post suboccipital craniotomy and resection of the posterior arch of C1. There is a fluid collection present behind the C1 arch measuring approximately 33 x 12 mm axial dimensions which are stable compared to the prior exam. There is redemonstration of stent coursing through the foramen Magendie and into the fourth ventricle with tip at the top of the fourth ventricle. It is unchanged in positionCSF flow study indicates biphasic flow without any convincing evidence for obstruction at the level of the foramen magnum. Flow is also identified through the shunt tubing.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. There is no evidence for syrinx.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.At 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.
1.Status post surgery for Chiari malformation with shunt placement. There is no evidence for obstruction to CSF flow. The postoperative findings including a small fluid collection overlying the dura are stable.2.There is no evidence for ventriculomegaly or syrinx.