 Images are slightly limited by patient motion. There is again a pointed configuration of the cerebellar tonsils although which descend 5-6 mm below the level of the foramen magnum, with associated mild crowding. There is a relative shallow clival angle with positioning on the current exam. CSF flow imaging demonstrates biphasic CSF flow at the foramen magnum ventrally and dorsally with the visualization of flow through the cerebral aqueduct and fourth ventricle.There is stable appearance of focal central T2 hyperintensity within cord extending to a subtle fashion up to the C6 level down to the tip of the conus at the L1-L2 level. This has slightly increased in size with maximal dimensions now 6 x 6 mm at the mid to lower T7 level on 1301/39, previously measuring 5 x 5 mm at this level.The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The marrow signal is unremarkable. There is no significant spinal canal stenosis. The conus terminates at L1-L2.There is significant prominence of the soft tissue along the posterior nasopharynx in the region of the adenoids and lingual tonsils likely representing reactive lymphoid tissue in a patient of this age. There is severe bilateral mastoid air cell fluid opacification which is partially visualized. There is also opacification of visualized paranasal sinuses.
1. Stable appearance of Chiari 1 malformation with presence of biphasic flow both ventrally and dorsally along the foramen magnum.2. Slight increased degree of syringohydromyelia extending from the level of C6 to the conus, now measuring up to 6 mm in diameter.