Reason: Chiari malformation status post decompression. VP shunt, Syrinx. Weakness, headaches, difficulty walking , increase in syrinx size on recent MRI , repeat in 3 months History: expanding syrinx, shunt, chiari , worsening symptoms Again seen are postsurgical changes of prior Chiari decompression with suboccipital craniectomy and resection of the posterior arch of C1. Left cerebellar encephalomalacia is partially visualized and present previously. Fourth ventricular stent partially visualized.There is no significant change in extensive cervical syrinx with septations compared to 4/30/2015. For example at the C1 level, syrinx measures 17 x 13 mm similar to prior. Inferiorly syrinx extends to the C7 level similar to prior with additional T2 hyperintensity extending down to the T1 level appearing slightly less prominent in the interval.Abnormal T2 signal in the thoracic cord bilaterally is again seen from T6 to T7 and appears similar on the sagittal sequences. Axial T2 sequence of the thoracic cord were not obtained as patient could not tolerate further imaging. There is mild prominence of the central canal slightly more inferiorly from T7 to T8 which also appears similar to prior based on the sagittal sequences. Again noted is mild deformity of the thoracic cord with asymmetric flattening of the left ventrolateral aspect of the cord at the T5 level better appreciated on prior axial thoracic images.Mild multilevel degenerative changes are again seen in the cervical spine. Schmorl's nodes with mild depression of the superior endplates involving the thoracic spine are also again noted involving the superior endplates at T7, T8, T9, and T10. Alignment is maintained. Bone marrow signal is benign.
Compared to 4/30/2015 there is overall no significant change in size or extent of large cervical syrinx extending from the cervicomedullary junction to the C7 level. Adjacent T2 signal abnormality extending more inferiorly from C7 to the T1 level however appears slightly decreased than before. Additional T2 signal abnormality involving the mid thoracic cord from T6 to T7 is also unchanged based on the sagittal sequences with patient not being able to tolerate further axial thoracic imaging. Contour deformity of the mid thoracic cord also remains unchanged which may be related to adhesions in the thecal sac from remote inflammation or surgical manipulation. No new cord signal abnormality.