Reason: Chiari decompression , cerebellar T2 signal changes, new symptoms , follow up evaluation for changes, new numbness tingling and pain to her feet and hands up to thighs History: new numbness Operative changes from suboccipital craniectomy related to Chiari decompression are again seen. The cerebellar tonsils extend to the upper margin of C1 through the neo-foramen magnum, unchanged. Patchy symmetric T2/FLAIR hyperintensity involving the pons is again seen and appears similar to prior examination. The cortical sulci and ventricles are in proportion. There is redemonstration of nonspecific linear T1 hyperintensity involving the inferior aspect of the pituitary gland, slightly better visualized compared to prior examination. The more posterior portion may represent an atypical posterior pituitary bright spot. The abnormal pituitary gland morphology appears grossly similar to prior examinations. No midline shift or mass effect is appreciated. The gray-white matter junction is preserved. There is no evidence for acute ischemia or intracranial hemorrhage.CERVICAL SPINE:There is mild straightening of the cervical lordosis which may be positional. The cervical vertebral body heights and intervertebral disc spaces are maintained. No significant disc herniation, neuroforaminal stenosis, or spinal stenosis is noted. The spinal cord demonstrate normal signal and morphology.THORACIC SPINE:Thoracic kyphosis is preserved. The vertebral body heights are maintained. A few scattered T1 hyperintense lesions visualized throughout the thoracic spine appears similar to prior examination and likely related to hemangiomas. Schmorl's node involving the superior and inferior endplate of the T7 vertebral body are again seen. There is redemonstration of a right paracentral T11-12 disc protrusion resulting in mild spinal stenosis. The thoracic spinal cord demonstrates normal caliber and signal intensity.LUMBAR SPINE:For the purposes of numbering, the inferior most fully formed intervertebral disc space is considered to be L5-S1. The lumbar lordosis is preserved. T1 hyperintense lesion in the L3 vertebral body likely relates to a hemangioma. The vertebral bodies and intervertebral disc spaces are preserved. No significant disc herniation, neuroforaminal stenosis, or spinal stenosis is noted. The conus terminates at L1. The cauda equina appear unremarkable.Small left greater than right pleural effusion. There is fluid present within the somewhat distended esophagus. Trace fluid is also seen along the dependent tracheal wall.
1. Redemonstrated postoperative changes from Chiari decompression without significant interval change of cerebellar tonsil morphology or position.2. No evidence of syringohydromyelia.3. Nonspecific patchy symmetric T2/FLAIR hyperintensity involving the pons appears similar to multiple prior examinations, possibly relating to previous osmotic demyelination.4. Small left greater than right pleural effusion. Please correlate clinically, and dedicated chest x-ray should be considered.5. The esophagus is distended with fluid and there is trace fluid present within the trachea, possibly related to reflux. Recommend correlation with symptoms.