Chiari, headaches, syrinx, back pain. Brain: Again seen are low-lying cerebellar tonsils measuring up to 6 mm below the foramen magnum. Cerebellar tonsils demonstrate a normal rounded morphology with preserved CSF spaces ventrally and dorsally. CSF flow sequence demonstrates good biphasic CSF flow ventrally and dorsally at the level of the foramina magnum. Remainder of the brain is unremarkable without evidence of ischemia, hemorrhage, mass, or mass effect. No extra-axial collections or hydrocephalus. Major flow-voids are preserved. Again seen is a relatively large mucous retention cyst in the right maxillary sinus, and was present on prior. Paranasal sinuses are otherwise clear. Sella and orbits are grossly unremarkable. Bone marrow signal and extracranial soft tissues are within normal limits. Spine:Cervical: No abnormal signal seen within the cervical cord. No evidence of syrinx. There are mild degenerative changes with loss of normal cervical lordosis. Vertebral body heights are maintained. There are mild disk bulges from C3-C4 to C6-C7 with partial effacement of the ventral thecal sac. Relatively largest of these is at the C6-C7 level and associated with mild bilateral neural foramina stenosis. Disk bulges are minimally worse since prior. No significant spinal canal stenosis at any level is seen.Thoracic: There is trace prominence of the central canal from the T3 to the T10, relatively greater from T6 to T9, and not significantly changed from MRI from 2009. Otherwise no discrete syrinx is appreciated in the spinal cord. Conus is in normal position at the L1-L2 level. Vertebral body heights and alignment are maintained. Bone marrow signal is within normal limits. There is no significant disk disease, spinal canal, or neural foramina stenosis in the thoracic spine.Lumbar: Vertebral body heights and alignment are maintained. Bone marrow signal is within normal limits. There is no significant disk disease, spinal canal, or neural foramina stenosis in the lumbar spine. Unremarkable appearance of the conus, filum, and cauda equina nerve roots.
1. Mild cerebellar tonsillar ectopia with otherwise preserved CSF spaces and CSF flow at the level of the foramen magnum. 2. Mild prominence of the central canal/tiny syrinx in the thoracic cord remains unchanged. 3. Mild degenerative changes in the cervical spine with multilevel disk bulges and mild bilateral neural foraminal narrowing at C6-C7 level. These appear minimally worse compared to 2009.