History of hydrocephalus, neurogenic bladder, neurogenic dysphagia, vocal tremor, cerebral cyst, Chiari malformation with decompression, syrinx, ataxia, headache, falls, complicated UTI, hypothyroidism, and VA shunts. Brain: There are postoperative findings related to complex Chiari decompression surgery with extensive encephalomalacia and punctate foci of susceptibility effect in the medial portions of the cerebellum and left middle cerebellar peduncle. There is interval involution of the cystic cavity in the left cerebellomedullary angle cistern, while the cystic compartment in the right cerebellomedullary angle cistern persists, measuring 9 x 12 mm in axial cross-section. There is interval decreased T2 hyperintensity and swelling of the bilateral medullary olives. There is no evidence of acute infarct. There is a left transparietal ventricular shunt catheter that terminates in the right frontal horn. The third and lateral ventricles are nearly collapsed. There is linear encephalomalacia that traverses the body of the corpus callosum into the bilateral centrum semiovale. There is also a prior left transfrontal catheter track. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits are unremarkable.Spine: There are postoperative findings related to complex Chiari decompression surgery with a persistent transverse low signal band that kinks the anterior aspect of the upper spinal cord at the level of the dens. There is persistent extensive central T2 hyperintensity throughout the cervical and upper thoracic spine. There is persistent lack of the usual cervical lordosis. The rest of the vertebral column alignment is otherwise anatomic. There is prominence of the epidural venous plexus in the anterior craniocervical junction region. There are scattered extramedullary intrathecal foci of low signal intensity throughout the spinal canal, particularly posteriorly. There also appears to be clumping of the lower cauda equina nerve roots. There is a small posterior disc-osteophyte complex at the C6-7 level, but no significant degenerative spondylosis in the thoracic and lumbar spine. The vertebral body heights are preserved.
1. Postoperative findings related to complex Chiari decompression surgery with persistent encephalomalacia and punctate foci of chronic hemorrhage in the medial portions of the cerebellum and left middle cerebellar peduncle and a cystic compartment in the right cerebellomedullary angle cistern, but interval involution of the cystic cavity in the left cerebellomedullary angle cistern. 2. Persistent extensive central T2 hyperintensity throughout the cervical and upper thoracic spine, which may represent a combination of edema and myelomalacia, perhaps aggravated by a persistent apparent fibrotic band that kinks the upper spinal cord at the level of the dens.3. Scattered extramedullary intrathecal foci of low signal intensity throughout the spinal canal and apparent clumping of the lower cauda equina nerve roots, which may be related to arachnoiditis incited b7 chronic hemorrhage. 4. The shunted third and lateral ventricles are nearly collapsed. 5. Interval evolution of hypertrophic olivary degeneration, which is now less conspicuous. 