Female, 29 years old, with history of Chiari decompression and foramen magnum to atrial shunt, complaining of ataxia and memory issues. Brain:Artifact from the patient's shunt apparatus mildly obscures visualization of the right occipital lobe and posterior fossa. Within this limitation, no new or concerning intracranial lesions are detected. There remains curvilinear T2 hyperintensity traversing the right frontal lobe into the genu of the corpus callosum which may reflect prior instrumentation.No evidence of restricted diffusion, parenchymal edema or mass effect is detected. No intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular caliber is small but this is unchanged and the morphology is unremarkable. C-spine:Postop findings are redemonstrated compatible with Chiari decompression. The appearance of the cerebellar tonsils is unchanged. There remains evidence of CSF space expansion at the level of the foramen magnum. Fairly robust biphasic CSF flow is evident anteriorly through the foramen magnum with minimal flow posteriorly, findings which are similar to those seen on the prior study.A catheter is faintly visualized entering the spinal canal posteriorly at the level of the foramen magnum, coursing to the left lateral aspect of the thecal sac, and down to approximately the C5 level where it seems to terminate. This positioning is similar to that noted on the prior exam.The spinal cord itself is normal in morphology and signal characteristics. No evidence of syrinx formation is seen.Slight straightening of the normal cervical adenosis is demonstrated. The cervical vertebral bodies are slender but this is unchanged. Alignment and morphology are otherwise unremarkable. No concerning marrow signal abnormality is detected.No evidence of significant disk degeneration is seen. The spinal canal and neural foramina remain patent.
1.Stable evaluation of the brain with no specific findings to account for the patient's symptoms.2.Redemonstration of findings related to Chiari decompression. The shape and position of the cerebellar tonsils is unchanged. Robust CSF flow is evident anteriorly through the foramen magnum, with minimal flow posteriorly, findings which are unchanged.3.No evidence of spinal cord syrinx or other specific cervical spine abnormalities to account for the patient's symptoms.