29 years, Male, headache, evaluate Chiari decompression and syrinx. Additional history per chart, hx of SAH as child, chiari decompression, cervical syrinx, SVT, LPS & VPS presents with 3 week history of worsening headache, worsening nausea, blurred vision & gait instability. Brain: Again seen are postoperative findings related to right PICA aneurysm clipping as well as suboccipital craniotomy for Chiari decompression. There is artifact related to the aneurysm clip, which obscures the surrounding anatomy. There is encephalomalacia and susceptibility effect in the right caudate head likely related to prior hemorrhage. The ventricles are not significantly changed in size and configuration compared to 8/12/2015 MRI, with a left transparietal ventricular shunt catheter unchanged in position. Prior additional ventriculostomy tracts are also evident. There is no evidence of acute infarction. The cerebellum assumes an unchanged position and configuration. Unchanged signal abnormality involving the right cerebellar tonsil consistent with post treatment change. Susceptibility artifact related to aneurysm clip limits assessment for CSF spaces and flow dorsally at the foramen magnum; there is however preserved ventral CSF space at the foramen magnum with preserved biphasic flow.Cervical and Thoracic Spine:There is no significant change in size of the cervicothoracic syrinx. For example the syrinx at the C1-C2 level measures 2 x 5 mm in the AP and transverse dimensions, not significantly changed. In the lower cervical cord the syrinx occupies the right aspect of the cervical cord as before. There may be minimal decrease in component of the syrinx. For example at the mid C6 level, syrinx measures approximately 2.5 mm in the AP dimension, previously 2.7 mm. No significant change in the caudal extent of the syrinx which is at the lower T10 level. Unchanged reversal of cervical lordosis. Moderate degree of thoracic scoliosis with apex at approximately the T8 level is again noted and better assessed with standing radiographs. There is no significant spinal canal stenosis at any level. Bone marrow signal is benign.
1. Compared to prior brain MRI from 8/12/2015 there is no significant change in findings of Chiari decompression and left parietal ventriculostomy. Unchanged caliber of the ventricular system. Also evidence of prior right PICA aneurysm clipping.2. Compared to prior spine MRI from 8/12/2015 there is overall no significant change in the caliber or craniocaudal extent of the syrinx, although there are levels where the syrinx measures minimally smaller than prior.