Benign intracranial hypertension [348.2] / Encounter for other specified aftercare [V58.89] / Compression of brain [348.4], Reason for Study: ^Reason: Chiari malformation , please do with CSF flow study post Chiari decompression. Brain MRI:There is evidence of suboccipital craniectomy. No evidence of acute ischemic or hemorrhagic lesion on this scan.The ventricles, sulci and cisterns are symmetric and unremarkable. The gray-white matter differentiation is normal. There is no mass, mass effect, edema, midline shift, intra or extra-axial fluid collection/hemorrhage, or restricted diffusion/acute ischemia. Normal flow voids are identified in the major intracranial vessels. The paranasal sinuses and mastoid air cells are clear.C-Spine MRI:Suboccipital craniectomy is again seen.There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. There are minimal central focal bulging of discs at the level of C34, 45, 56 and C67 without evidence thecal sac compression.CSF Flow study:The brain CSF flow study does not include phase imaging sets. On magnitude images which might include some of phase images, demonstrated normal craniofugal and cranio petal flow of the CSF through the foramen magnum. However, there is minimal craniofugal flow on the posterior aspect of the foramen magnum including upper cervical level CSF flow. There are however, minimal cranio petal flow on the posterior aspect of the cerebellar hemisphere. Above findings suggest the CSF flow of the posterior aspect of foramen magnum and upper cervical cord appears to be restricted but the anterior aspect of foramen magnum and upper cervical cord appears to be maintained and the magnitude of the flow appears to be slightly decreased comparing to that of the anterior aspect of the brain stem.
1. Post suboccipital craniectomy status due to Chiari malformation.2. No evidence of acute ischemic or hemorrhagic lesion. Ventricle size appears to be normal.3. CSF study shows decreased flow but maintaining pulsatile flow on the anterior aspect of the foramen magnum and upper cervical cord. However, posterior aspect of the foramen magnum and upper cervical cord level appears to be restricted.