18 years, Female, status post occipital craniectomy for Chiari malformation, C1 laminectomy and dural graft. Evaluate for postoperative changes. BRAIN: Interval postsurgical changes of Chiari decompression are seen with suboccipital craniectomy and resection of the posterior arch of C1. There is increased fluid/CSF space dorsally at the C1 level. There are foci of hemorrhage. The CSF spaces, both ventrally and dorsally, are improved. There are new areas of restricted diffusion within the inferior aspect of the cerebellum bilaterally, right greater than left, consistent with acute infarcts. The ventricles are unchanged in size and configuration. There is no evidence of hydrocephalus. The corpus callosum appears mildly dysmorphic, but fully formed unchanged from prior. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. There are secretions within the bilateral mastoid air cells. There is mild mucosal thickening of the ethmoid air cells, unchanged. There is decreased opacification of the bilateral maxillary sinuses and persistent left mucous retention cyst. CERVICAL SPINE: There is decrease in size of the cervical cord related to improved edema. There is mild ill-defined hyperintense T2 signal within the upper cervical spinal cord including a small syrinx, markedly decreased compared to May 13, 2015 and slightly decreased compared to June 15, 2015. The cervical spine alignment is within normal limits, with preserved cervical lordosis. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis.
1.Postsurgical changes of Chiari decompression with improvement in CSF spaces and flow at the foramen magnum. 2.Interval development of acute infarcts involving the bilateral cerebellar hemispheres, right greater than left, in a PICA distribution. 3.Edema within the cervical cord including a small syrinx is markedly improved from May 13, 2015 and slightly decreased from the prior study June 15, 2015.Findings were discussed with Advanced Practice Nurse Gina Bradley at 4:54 PM on July 2, 2015.