Clinical question: Chiari malformation, CSF flow study, back pain. Signs and symptoms: As above. Cervical MRI:Examination demonstrates ectopia of cerebellar tonsils of approximately 9 mm with flattening deformity of the inferior poles of the tonsils and consistent with patient's known Chiari malformation. There is normal signal intensity and caliber of the cervical cord and in particular without intravenous syrinx. Signal intensity and alignment of vertebral column is within normal and without spinal stenosis or neural foraminal compromise at any level.CSF flow study demonstrates uncompromised biphasic CSF flow study through the foramen magnum anteriorly. Minimal biphasic flow through the foramen magnum is detected posteriorly and with subtle flow through the fourth ventricle and the aqueduct. 3-D fiesta sequences demonstrate patent aqueduct.Nonenhanced thoracic MRI:There is normal signal intensity and caliber of thoracic cord and in particular without evidence of syrinx. The signal intensity and alignment of vertebral column is unremarkable and without evidence of spinal canal or neural foraminal compromise at any level.Nonenhanced lumbar MRI:Examination demonstrates normal anatomical development of vertebral column with normal signal intensity and alignment. There is normal signal intensity and morphology of the lower most visualized thoracic cord, conus and the cauda equina and normal termination of the cord at L1-L2 level.
1.Chiari malformation with approximately 9 mm with flattening deformity of cerebellar tonsils as detailed.2.CSF flow study demonstrates uncompromised presence of biphasic flow through the foramen magnum anteriorly. Diminished flow posteriorly through the foramen magnum, fourth ventricle and the aqueduct as detailed.3.Normal signal intensity and caliber of cord without evidence of syrinx and with normal termination at L1-L2 level.4.Unremarkable MRI of the lumbar spine and with normal signal intensity and morphology of conus and cauda equina as detailed. 