Clinical question: Evaluate syrinx, structural lesion. Signs and symptoms: Myoclonus and dystonia. Pre and post enhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrates normal anatomical development and morphology of the brain parenchyma and with normal signal intensity on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination.No detectable abnormal parenchymal, leptomeningeal, calvarial, or soft tissues of the scalp or retro-orbital enhancement.Normal visualization of signal void of major intracranial arterial branches.Normal signal intensity of the intracranial venous sinuses and with normal pattern of enhancement.Unremarkable orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with straightening of cervical lordosis.There is generalized uniform smaller than expected caliber of the spinal canal believed to represent a congenital anatomical variation of short pedicles.Foramen magnum is unremarkable.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord without evidence of syrinx.CSF flow study demonstrate normal biphasic flow through the foramen magnum both anterior and posterior to the cord. There is also detectable biphasic flow through the fourth ventricle.Axial images are degraded due to motion artifact which makes precise assessment for subtle findings including neural foraminal compromise difficult.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes and unremarkable otherwise.C4-C5 demonstrate mild degenerative changes and unremarkable otherwise.C5-C6 demonstrate moderate disc disease with loss of disc height and moderate right neural foraminal compromise.C7 is unremarkable.C7-T1 is unremarkable.
1.Negative pre and post enhanced brain MRI.2.Nonenhanced cervical MRI demonstrate congenitally small spinal canal. Unremarkable foramen magnum. Normal signal intensity and caliber of the cervical and upper most visualized thoracic cord to T2 level. Mild degenerative changes and unremarkable exam otherwise.3.CSF flow demonstrate biphasic flow through the foramen magnum both anteriorly and posteriorly and through the fourth ventricle.