42 years Female (DOB:12/8/1973)Reason: Chiari decompression, Lp shunt, with new symptoms, evaluate for changes History: new headaches, neck pain, dizziness.PROVIDER/ATTENDING NAME: DAVID M. FRIM DAVID M. FRIM MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. Incidental note is made of partial empty sella.The cerebellar tonsils extend approximately 3 mm below the level of foramen magnum. CSF flow at the level of the foramen magnum is within normal limits.There several periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. This is stable compared to prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. There is multilevel disc desiccation present.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. There are small uncovertebral osteophytes at this level mildly narrowing the neural foramina.At C5-6 there is loss of disc space height, disc desiccation and a disc bulge associated with small uncovertebral osteophytes and mild narrowing of the neural foramina bilaterally. There is encroachment of the right-sided exiting nerve roots and to a lesser degree left-sided exiting nerve roots due to uncovertebral osteophytes. There is partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is mild spinal stenosis at this level. This is stable compared to the prior exam.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.
1.There are mild degenerative changes present in the cervical spine without significant compromise to the spinal canal. There is mild encroachment of exiting nerve roots at C5-6 due to uncovertebral osteophytes which appear worse on the right compared to the left side. This is stable compared to the prior exam.2.The cerebellar tonsils are low lying which is borderline for Chiari I malformation. There is no evidence for ventriculomegaly or syrinx and no CSF flow obstruction at the level of the foramen magnum. This is stable compared to the prior exam.3.Several periventricular and subcortical white matter are present which are nonspecific and not unusual in this number at this age. They are therefore of little clinical significance. This is stable compared to the prior exam.