Male, 37 years old, with history of spina bifida, tethered cord, hydrocephalus and gait difficulties. Evaluate for tethered cord, syrinx. Brain:Bilateral parietal approach ventricular catheters are in stable position terminating along the lateral ventricular bodies. Irregular ventricular margination and T2 hyperintensity with cystic spaces along the margins of the ventricles, particularly at the level of the left atrium, are unchanged. The ventricles remain largely decompressed.Chronic cerebral dysmorphism is unchanged including atrophy and perhaps partial agenesis of the corpus callosum and anomalous cortical development along the cingulate gyri. A severely dysmorphic single-lobed cerebellum is also unchanged.The previously stented basilar aneurysm is not adequately assessed on this examination. No new intracranial lesions are seen including no evidence of parenchymal edema, mass effect or restricted diffusion. No evidence of any new intracranial fluid collection is seen.C-spine:The cervical lordosis is mildly reversed. Vertebral body height and morphology are unremarkable. No concerning marrow replacement or marrow edema is seen.The spinal cord becomes slender at lower cervical levels, but is otherwise normal in morphology. No discrete cord signal abnormality is detected.Small disc osteophyte complexes are evident at multiple cervical levels, similar to prior, causing no significant spinal canal stenosis. Mild left foraminal narrowing is seen at C4-5 and C5-6 secondary to uncovertebral and facet hypertrophy.No significant interval change is seen in these cervical spine findings.T-spine:Evidence of laminectomy is again seen beginning at T5 and continuing at least to the T10-11 levels.A mild scoliotic curvature of the thoracic spine is seen. Vertebral bodies are well aligned in the sagittal plane.Vertebral body height is normal. There may be mild posterior vertebral body scalloping through the mid thoracic spine with corresponding areas of thecal sac dilatation or ectasia. No evidence of concerning marrow replacement or marrow edema is seen.The spinal cord remains diffusely thinned suggesting atrophy. At lower thoracic levels, the cord assumes a triangular configuration which may reflect some degree of adhesive traction. Ultimately, the cord flattens and spreads along the posterior aspect of the thecal sac. These findings have not significantly changed.Small disc protrusions at T7-8 and T8-9 may be new from the prior examination. No significant spinal canal or neuroforaminal stenosis is seen.Cystic degeneration of the left kidney is again seen. The overall size of the kidney has decreased substantially from the prior examination.L-spine:Imaging of the lumbar spine is significantly motion degraded.Spinal alignment is anatomic allowing for a mild scoliotic curvature. The vertebral body heights are normal. No concerning marrow signal abnormality is seen.Continuing from the thoracic region, the spinal cord remains thinned and spread along the posterior aspect of the thecal sac. At the L1 level, it resumes a more rounded conformation and continues inferiorly to the L5-S1 level where it thins and eventually blends with the posterior margin of the thecal sac. The posterior elements in this region are deficient allowing the distal thecal sac to closely approach the skin surface.Disc bulging at L2-3 has progressed mildly. This contributes along with facet hypertrophy to a significant spinal canal stenosis and at least moderate right neuroforaminal narrowing.Disc bulging has also progressed at L3-4 where it contributes with posterior element hypertrophy to a mild spinal canal narrowing and moderate right foraminal narrowing.
1.No significant interval change in chronic/congenital anomalies of the brain and cerebellum. No new intracranial lesions are seen. The shunted ventricular system is unchanged in size and configuration.2.The gross morphology of the spinal cord, as well as findings compatible with tethered cord, are unchanged. No new intraspinal lesions are seen.3.Mild progression of degenerative findings at several levels as discussed above.