 Brain: Examination is limited to axial T2 sequences. Increased dilatation of the lateral, third, and fourth ventricle when compared to the prior study. For example, the third ventricle previously measured 16 mm, currently 20 mm in diameter. The fourth ventricle is particularly expanded when compared to prior study, currently measuring 30 mm in transverse dimension, previously 24 mm, with dilatation extending caudally to the level of the obex. There is increased effacement of the prepontine cistern and increased dorsal scalloping of the brainstem. There is no midline shift or uncal herniation. There is evidence of transependymal flow. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. There is minimal scattered mucosal thickening in the right maxillary sinus and anterior ethmoid air cells. There are postoperative findings related to Chiari decompression.Cervical Spine: Limited sagittal T2 images were acquired. Patient is status post Chiari decompression. The septated cervicothoracic syringohydromyelia now extends cranially to the obex. At the C1 level, the syrinx currently measures 11 x 13 mm in the axial plane, previously 3 x 4 mm. Based on sagittal imaging, there is increase in dimension of the syrinx, particularly within the upper cervical spine, with associated increase in expansion of the cervical cord. However, there is slight decrease in size of the syrinx within the upper thoracic cord. There is focal severely diminished CSF flow ventrally and dorsally at the foramen magnum. Straightening of the normal cervical lordosis. No worrisome focal marrow signal abnormality is appreciated. There is no significant spinal canal stenosis.
1.Interval increase in dilatation of the lateral, third, and fourth ventricles compared to MRI from 9/2/2015.2.Increase in caliber of the syrinx particularly at the upper cervical cord level and obex. Syrinx involving the partially imaged upper thoracic cord appears decreased since 9/2/2015 based on the sagittal images.3.Examinations of the brain and cervical cord were abbreviated due to patient's condition.