Female, 51 years old, with history of migraines and pain concerning for occipital and trigeminal neuralgia. Posterior neck pain radiating to the right side of the head and face. Brain:No evidence of significant parenchymal signal abnormality is seen. At most, there may be one or two scattered small foci of nonspecific FLAIR hyperintensity. No edema or mass effect is detected. No pathologic parenchymal or extra-axial enhancement is observed. There are no abnormal extra-axial fluid collections or evidence of acute intracranial hemorrhage. The ventricles are normal in size morphology. The right cerebellar tonsil descends 2-3 mm below the level of the foramen magnum.Cervical spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. A 10 mm T2-hyperintense enhancing lesion is evident within the left aspect of the T2 vertebral body. This lesion is vaguely discernible on the prior chest CT and demonstrates nonaggressive features. Elsewhere no significant marrow replacement, edema or pathologic marrow enhancement is observed.The visualized spinal cord shows normal signal intensity and morphology. No pathologic parenchymal or leptomeningeal enhancement is seen. No epidural abnormalities are suspected.Minimal posterior disc-osteophyte complex formation is seen throughout the cervical spine with no areas of significant spinal canal or neuroforaminal compromise.
1.No significant brain parenchymal abnormalities are identified to account for the patient's symptoms. The right cerebellar tonsil is low-lying but does not meet imaging criteria for a Chiari I malformation.2.A lesion within the T2 vertebral body is favored to represent an atypical hemangioma. No other specific spinal abnormalities are seen which would account for the patient's symptoms.