Clinical question: Neck pain. Signs and symptoms: Neck pain. Nonenhanced cervical MRI:Images at the level of foramen magnum demonstrate herniation of the cerebellar tonsils are approximately 11.5 mm with expected flattening deformity of the tonsils and effacement of subarachnoid space. Finding consistent with Chiari malformation.There is also moderately expansile syrinx involving the entire cervical cord and extending to the upper most visualized thoracic cord to T5 level. Follow-up with dedicated MRI of thoracic and lumbar spine is recommended for further assessment.The syrinx is more expanded from C3-C4 disc level to C6-C7 disc level. It measures maximum of approximately 10 x 5.7 mm in transaxial dimensions at C5-C6 disc level. The signal intensity of the expanded cord beyond the syrinx remains within normal.The signal intensity and alignment of vertebral column is unremarkable and there is no evidence of spinal canal or neural foraminal compromise at any level.
1.Chiari malformation with 11.5 mm herniation of cerebellar tonsils and expected flattening deformity of the tonsil and effacement of subarachnoid space.2.Syrinx of entire cervical cord and extending to the upper most visualized thoracic spine to T5 level as detailed/measured above.3.Follow-up with MRI of thoracic and lumbar spine and CSF flow study at the level of foramen magnum is recommended.