 CSF FLOW: There is diminished biphasic flow at the level of the foramen magnum worse posteriorly than anteriorly. There is effacement of the CSF spaces secondary to marked crowding of the medulla and cerebellum, similar to prior exam. There is inferior herniation of the cerebellar tonsils measuring up to 11 mm below the foramen magnum with a pointed cerebellar tonsillar tip morphology. As seen on recent brain MRI, there is dilatation of the ventricular system which is in part related to periventricular leukomalacia right worse than left with superimposed mild obstructive hydrocephalus. Cerebellar aqueduct is patent.CERVICAL: There appears to be congenitally narrow cervical spinal canal. There is loss of normal cervical lordosis which may be in part positional. The osseous marrow signal is benign. Vertebral body heights are preserved. There is no cervical cord syrinx or significant signal abnormality. There are no significant disk disease or focal high-grade spinal canal or neural foraminal stenosis.There is a retention cyst in the left maxillary sinus.THORACIC: There is congenital narrowing of the upper and mid thoracic spinal canal. There is mild epidural lipomatosis. The vertebral body heights and signal are normal. There is no significant disk herniation, or focal high-grade spinal canal or neural foraminal stenosis in the thoracic spine. There is no thoracic cord syrinx or significant cord signal abnormality.LUMBAR: The vertebral body heights and marrow are within normal limits. The intervertebral disks show normal signal intensity. There are minimal disk bulges at L3-4, L4-5 and mild disk bulge at L5-S1. There is mild facet hypertrophy in the lower lumbar spine. There is no central spinal canal or significant neural foramina stenosis at any level. No spinal dysraphism. The conus terminates at mid L2 within normal limits. There is no lipoma or other masses in the lumbar spinal canal.
1. As seen on recent brain MRI, there are findings consistent with Chiari I malformation with significant crowding at the craniocervical junction and inferiorly displaced cerebellar tonsils with pointed morphology. Diminished biphasic CSF flow is noted at the level of the foramen magnum, worse posteriorly than anteriorly. Dilatation of the ventricular system is better assessed on recent brain MRI which is primarily related to periventricular leukomalacia, right worse than left, with suspected superimposed mild obstructive hydrocephalus. 2. No evidence of syrinx or signal abnormalities in the spinal cord.3. Congenital narrowing of the cervical and thoracic spinal canal. There is also mild thoracic epidural lipomatosis. No focal high-grade stenosis at any level.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.