 MRI brain:Significantly limited exam given the artifact from the patient's dental hardware which obscures the face region on all sequences. The face and anterior half of the brain are obscured on susceptibility sequences. The DWI sequences are essentially nondiagnostic secondary to artifact. There is significant artifact obscuring the base of the brain and face on the postcontrast T1 sequences.The right cerebellar tonsil protrudes 2.0 cm below the foramen magnum and the left cerebellar tonsil protrudes 1.1 cm below the foramen magnum, which results in moderate to severe crowding at the level of the foramen magnum. However, the brainstem appears intact and in normal position and there is no evidence of hydrocephalus. These findings are compatible with Chiari I malformation. On CSF flow sequences, there is apparent diminished CSF flow at the level of the foramen magnum and cerebellar tonsils. The CSF flow appears more robust along the upper cervical spinal canal and therefore some of this apparent diminished CSF flow at the craniocervical junction may be artifactual. Similarly, the apparent lack of visible flow through the cerebral aqueduct and fourth ventricle may at least partially be from artifact from the dental hardware.The ventricles and sulci are within normal limits. The cisterns remain patent. There is no midline shift or mass effect. There are no areas of abnormal signal or pathological enhancement. There is no diffusion abnormality. No extra-axial fluid collection is identified. Normal flow-voids are demonstrated in the major intracranial vascular structures. MRI complete spine:Within the cervical spine, dental artifact obscures the prevertebral soft tissues of the neck. Within these limitations, the spinal cord is of normal caliber and signal and in particular, there is no evidence of a syrinx anywhere in the spinal cord. The spine is in normal alignment. The vertebral body and disk heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. The distal spinal cord and conus are within normal limits with the conus terminating at the lower L1 level. There is no significant disk bulge, herniation, spinal canal or foraminal stenosis within the spine.
1.Limited exam secondary to artifact from the dental hardware. 2.Within these limitations, there is evidence of significant Chiari I malformation with the right cerebellar tonsil protruding 2.0 cm the foramen magnum and the left cerebellar tonsil protruding 1.1 cm below the foramen magnum, with moderate-severe crowding. 3.Limited CSF flow evaluation due to dental hardware. Apparent diminished CSF flow at the level of the foramen magnum and cerebellar tonsils which may in part be artifactual. Similarly, the apparent lack of visible flow through the cerebral aqueduct and fourth ventricle may at least partially be artifactual. Follow-up CSF flow imaging recommended once braces are removed.4.There is no evidence of hydrocephalus and the remainder of the visualized brain is otherwise within normal limits.5.No evidence of a syrinx or other abnormality within the spinal cord.