History of intractable hiccups, assess for changes, especially brainstem. History of seizures and developmental delay. MRI brain: There is no diffusion abnormality. There is mild prominence of the ventricular system and the sulci, unchanged from the prior exam. The brainstem may be slightly smaller than normal, unchanged. There are no findings of cortical dysplasia or gray matter heterotopia. Otherwise, the brain parenchyma and pituitary gland appear unremarkable. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI cervical spine: There is evidence of orthopedic instrumentation involving C1-C2 level with some deformity of the odontoid process. A scoliotic curvature is evident affecting the lower cervical and thoracic spine. The cervical vertebral bodies are appropriate in overall height and morphology . The cervical spinal cord shows normal signal characteristics and morphology.The left-sided neural foramina appear narrower than the right with questionable left facet hypertrophy. Findings may be related to the spinal curvature. There is no significant disc disease. There is no evidence of spinal canal stenosis.The paraspinal soft tissue structures are unremarkable.
1. Mild global parenchymal volume loss, including the brainstem. No changes from the prior exam.2. Evidence of prior surgery at C1-C2. No significant canal stenosis or spinal cord abnormalities.