35 years, Female, Chiari, evaluate abnormal spinal cord T2 signal change, worsening symptoms. Left arm weakness, poor balance, headaches, syrinx, Chiari. Brain: There is evidence of Chiari I malformation with evidence of cerebellar tonsillar herniation which extend to the C1 level. There is also caudal herniation of the brainstem with the lower aspect of the pons just above the level of the foramen magnum and portions of the medulla inferior to the foramen magnum. Peglike cerebellar tonsils measure up to 8 mm below the foramen magnum. There is cervicomedullary kinking. There is mild prominence of the ventricular system without evidence of transependymal CSF flow. There is severe crowding at the foramen magnum with severely diminished CSF flow focally at this level.No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. Tiny nonspecific focus of T2/FLAIR hyperintensity in the right frontal lobe is nonspecific. No intracranial mass. No suspicious parenchymal or meningeal enhancement. Left frontal developmental venous anomaly incidentally noted. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Mild mucosal thickening is seen in the left maxillary sinus.Cervical spine:There is a small syrinx at the C2 level measuring 2 x 3 mm. There is also trace prominence of the central canal measuring 1 to 2 mm at the C6 level. Vertebral body heights and alignment in the cervical spine are maintained. There is a T2 hyperintense lesion involving the C6 vertebral body measuring approximately 1 cm in diameter with mild nodular enhancement peripherally. Bone marrow signal is otherwise unremarkable. No significant spinal canal or neural foraminal stenosis appreciated at any level in the cervical spine.
1. Findings of Chiari I malformation including cerebellar tonsils which measure up to 8 mm below the foramen magnum. There is significant crowding at the foramen magnum with severely diminished CSF flow at this level. Small syrinx at the C2 level measures 2 x 3 mm. There is also trace prominence of the central canal at the C6 level measuring 1 to 2 mm. No significant change since 10/30/2015.2. Unchanged mild prominence of the ventricular system. No transependymal flow is appreciated.3. T2 hyperintense lesion involving the C6 vertebral body may represent an atypical hemangioma but is nonspecific. This lesion appears similar to prior.