Patient with headaches, evaluate for CSF flow through foramen magnum and CSF leak in the lumbar spine. Head: There is no evidence of intracranial hemorrhage, mass, or acute infarct. The brain parenchyma and pituitary gland appear unremarkable. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The cerebellar tonsils are in normal position and demonstrate preserved rounded morphology. CSF flow sequence is technically degraded however there is flow ventrally and dorsally at the foramen magnum. No abnormal intracranial enhancement identified.Lumbar spine:Low-lying conus near the lumbosacral junction and postoperative changes related to prior cord untetherings again seen. Distal thecal sac is ectatic and demonstrates septations, findings which are not appreciably changed since 5/23/2016. No new or enlarging fluid collections. As before, the distal spinal cord abuts and may be adherent to the posterior thecal sac; re-tethering can be considered in the appropriate clinical setting.No significant change in diameter craniocaudal extent of distal cord syrinx compared to 5/23/2016 and 3/30/2016.Alignment is anatomic. Vertebral body heights and intervertebral disc spaces are preserved. The bone marrow demonstrates a normal signal. No spinal canal or neural foraminal stenosis.
1.MRI of the brain is within normal limits. CSF spaces at the foramen magnum are preserved. CSF flow sequence is technically limited but there is flow ventrally and dorsally at the foramen magnum.2.No significant change in diameter craniocaudal extent of distal cord syrinx compared to 5/23/2016 and 3/30/2016.3.Postoperative changes related to multiple cord untetherings. Unchanged appearance of the expanded distal thecal sac compared to study from 5/23/2016, compatible with post operative change. No new or enlarging fluid collections to suggest CSF leak. If there remains high clinical suspicion for an active CSF leak within this region, further evaluation with myelogram may be considered.