Diagnosis: Malignant neoplasm of cerebellumClinical question: history of ATRT s/p craniotomy, laminectomy, chemotherapy and radiation therapySigns and Symptoms: off therapy 4 1/2 years MRI brain:A ventriculostomy tube courses through the right occipital lobe into the trigone of the right lateral ventricle and has its tip at the quadrigeminal plate cistern. It is in stable position. There is redemonstration of a small focus of susceptibility effect at the tip of the ventriculostomy tube. The trigone of the right lateral ventricle is larger than the trigone of the left lateral ventricle. The temporal horns of the lateral ventricles are not dilated. These findings are stable.The patient is status post posterior fossa surgery. There is no evidence for abnormal enhancing mass intracranially. There is redemonstration and no change in the appearance of the cerebellum which is somewhat deformed.There is a punctate focus of signal hypointensity in the inferior aspect of the left cerebellar hemisphere on susceptibility imaging.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate a minor opacity in the right maxillary sinus. The paranasal sinuses have not fully developed. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:There is a large syrinx present which encompasses the majority of the spinal cord. Its superior extent is at the C2-3 disc space level. It is associated with enlargement of the spinal cord compared to the prior exam is not changed substantially.The cervical vertebral bodies are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:There is diffuse a syrinx present which is stable compared to the prior exam.The thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine.Lumbar spine:The inferior extent of the spinal cord is the L2-3 disc space level. There is redemonstration of a large syrinx is inferior extent is at the conus medullaris.The patient is status post lumbar spine surgery at the L4 vertebral level.There is redemonstration of a cystic type fluid collection in the right hemicanal which extends from the C2 vertebral body level down to the L5-S1 disc space level. It measures approximately 5 x 8 mm maximum axial dimensions. The nerve roots are displaced around this collection and possibly clumped.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. No abnormal enhancing lesions are identified in the lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.Examination is stable compared to prior exam. There is redemonstration of status post posterior fossa surgery and diffuse syrinx as well as a tethered cord and postoperative changes status post tethered cord release. 2.A cystic lesion in the lower lumbar spine is suspected to represent an arachnoid cyst. It is unchanged since the prior exam. The nerve roots are displaced around this collection and possibly clumped. Arachnoiditis cannot be excluded.