Cervicalgia with history of VACTERL BRAIN: The cortical sulci are in proportion to the cerebral ventricles. The gray-white matter differentiation is preserved. No midline shift or mass effect is appreciated. No gradient abnormality is identified. There is no diffusion restriction to suggest acute ischemia. The right internal carotid artery is not developed and the right middle cerebral artery originates from the P1 segment of the right posterior cerebral artery. The right anterior cerebral artery appears hypoplastic.CERVICAL SPINE: There is partial agenesis of the right posterior C1 vertebral body with fusion of the anterior aspect of the right C1 arch and occiput. The C2 vertebral body appears dysplastic. There is associated basilar invagination and moderate to severe narrowing at the foramen magnum with deformity of the medulla. However, no signal abnormality is demonstrated within the medulla or spinal cord. The cervical spine appears slightly straightened. The remainder of the vertebral body heights and intervertebral disc spaces are maintained. The left cerebellar tonsil appears pointed however does not extend below the foramen magnum. There is no syrinx.There is asynchronous prepontine biphasic flow, with diminished flow at the foramen magnum, particularly along the dorsal aspect.
1. Basilar invagination with moderate to severe narrowing at the foramen magnum and associated deformity of the medulla secondary to partial agenesis of C1 and dysplasia of C2 vertebral bodies as described above however without brainstem or spinal cord signal abnormality at this time.2. There is asynchronous prepontine flow with diminished flow at the foramen magnum, worse dorsally.3. The right internal carotid artery is not developed and the right middle cerebral artery originates from the P1 segment of the right posterior cerebral artery. The right anterior cerebral artery is hypoplastic.