19 years, Female, headache, facial pain. History of Chiari decompression. Additional history per EMR, also history of craniosynostosis reconstruction in 1997 and pseudotumor cerebri. Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are mildly dysmorphic but unchanged and without evidence of hydrocephalus. There are postsurgical changes of suboccipital craniectomy and resection of posterior arch of C1 for Chiari decompression. Unchanged encephalomalacia involving the inferior left cerebellar hemisphere. Unchanged contour of the calvarium with prior reconstruction for craniosynostosis. Sella and orbits are grossly unremarkable. There is mild opacification involving the right frontal sinus.There is unchanged appearance of the craniocervical junction compared to 10/19/2013, with marked improvement in previously seen posterior fossa crowding related to Chiari I seen on preoperative imaging from 2013, and no significant crowding on the current study. The dorsal cerebellar surface abuts the dura as before suggestive of scarring. CSF flow sequence demonstrates preserved biphasic flow ventrally, and also biphasic flow dorsally at the foramen magnum which terminates near the obex similar to prior.Cervical spine: The cervical spine is in normal alignment aside from mild straightening which may be positional. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The spinal cord is of normal caliber and signal without evidence of syrinx. There is trace prominence of the central canal at the C5 and C6-C7 levels and present on prior studies.There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the cervical spine.
1. No significant change in postsurgical changes of Chiari I decompression. No significant residual crowding in the posterior fossa. CSF flow sequence demonstrates robust biphasic flow ventrally and also posteriorly to the level of the obex.2. Trace prominence of the central canal in the lower cervical cord similar to prior and nonspecific. No evidence of a discrete syrinx.