Clinical question: Syrinx, evaluate for changes, history of Chiari decompression. Signs and symptoms: As above. Nonenhanced brain MRI:Examination demonstrate postoperative changes all Chiari decompression. There is inferior prolapse of the content of posterior fossa into the expanded subarachnoid space at the level of the compression. This appearance is identical to prior exam.Prominence of the supratentorial ventricular system and with maintained midline remains identical to prior exam. There is normal signal intensity of cerebral cortex and with normal myelination pattern. There is no detectable signal abnormality in the brain parenchyma. Compared to prior exam there is no evidence of any new findings.Nonenhanced MRI of cervical spine:Examination demonstrates an expansile syrinx of cervical cord without appreciable change since prior exam. Expansion of syrinx is largest at C6 and C7 disk level which is similar to prior exam. At this level also there is a central and immediate left median small disk protrusion with results in effacement of the ventral subarachnoid space and mild indentation of the cord similar to prior study.A faint focus of T2 hyperintensity superiorly at the level cervicomedullary junction of the cord remains similar to prior exam.The alignment the vertebral column is anatomical. This examination demonstrate no evidence of any new finding since prior study from 2014.CSF flow study demonstrate presence of biphasic flow with the foramen magnum anteriorly however similar to prior exam it demonstrate attenuation at the level of the tip of dens. Biphasic flow through the fourth ventricle and the aqueduct is identified.PC flow posteriorly through the foramen magnum is attenuated however present.Nonenhanced thoracic MRI:Examination demonstrates extension of significantly expanded syrinx of cervical cord into the thoracic cord and terminating at approximately mid L1 level. This finding remains identical to prior exam. The expanded syrinx in the cervical and thoracic region significantly occupies the subarachnoid space.There is normal signal intensity and anatomical alignment of the column. No detectable abnormality of the vertebral column.
1.Nonenhanced brain MRI demonstrate no evidence of acute or new finding since prior exam. Prolapse of the posterior fossa contents into the expanded subarachnoid space at the level of the craniectomy similar to prior exam. Stable postoperative changes of Chiari decompression and prominence of supratentorial ventricular system similar to prior study.2.Nonenhanced MRI of cervical and thoracic spine demonstrate a severely expanded syrinx of the cervical and thoracic cord spanning from mid C3 to lower L1 level without change. CSF flow study demonstrate presence of biphasic CSF flow anteriorly through the foramen magnum however with attenuation at the level of the tip of the dens similar to prior exam. Biphasic flow through the posterior aspect the foramen magnum is present however attenuated similar to prior study. Biphasic flow is also detected through the fourth ventricle and the aqueduct.3.A small central disk protrusion at C6 -- C7 with effacement of ventral subarachnoid space and subtle indentation of cord similar to prior exam.