Diagnosis: Tremor, unspecified Headache Arnold-Chiari syndrome without spina bifida or hydrocephalusClinical question: History of ChiariSigns and Symptoms: headache, numbness of left arm and hand MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. The cerebellar tonsils extend well below the level of the foramen magnum. The patient is status post Chiari I decompression. The CSF flow study demonstrates no obstruction to CSF flow.No abnormal enhancing 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. 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. There is a small central disk protrusion at this level.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a small central disk protrusion at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a small central disk protrusion at this level.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.Status post Chiari decompression without evidence for CSF flow obstruction, ventriculomegaly or syrinx.2.Minor degenerative changes are present in the cervical spine without significant compromise to the spinal canal or neural foramina.