New onset headache and visual changes (left hemiscinitillations transiently), psoriatic arthritis, possible lupus, and leukopenia. Brain: There cerebellar tonsils extend up to approximately 5 mm inferior to the foramen magnum, which appears to be crowded. The posterior fossa also has a small capacity. There is no evidence of intracranial hemorrhage, mass, or acute infarct. The supratentorial brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift. The major cerebral flow voids are intact. The skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable. However, there appear to be prominent upper neck lymph nodes.Orbits: The bilateral globes and ocular adnexa are unremarkable. There is no evidence of abnormal intraorbital enhancement or mass lesions.
1. Low-lying cerebellar tonsils in a configuration suggestive of Chiari 1 malformation.2. No evidence of acute intracranial hemorrhage, mass, or acute infarct.3. No evidence of orbital lesions.4. Prominent upper neck lymph nodes may be related to an autoimmune condition.