14 years, Male, severe frontal and at times occipital headache. Please evaluate for malformation of craniocervical junction and also for intracranial abnormalities. There is caudal descent of the cerebellar tonsils which measure up to 11 mm below the foramen magnum on the right and up to 7 mm on the left. There is mild crowding at the foramen magnum with partially diminished CSF spaces ventrally and dorsally. Cerebellar tonsils demonstrate a slightly elongated configuration. CSF flow sequence demonstrates present biphasic ventral and dorsal CSF flow, although mildly diminished posteriorly.No parenchymal signal abnormalities are seen. No intracranial mass. No midline shift or herniation. Ventricles are normal in size without evidence of hydrocephalus. No evidence of hemorrhage or ischemia. Major flow-voids are preserved. Bone marrow signal and extracranial soft tissues are grossly unremarkable. No syrinx is evident in the visualized cervical cord. Minimal T2 hyperintensity at the mid C2 level on the sagittal FIESTA sequence series 12 image 71 may be artifactual and not corroborated on additional sequences. Dedicated cervical spine MRI can be considered.
1. Findings compatible with a Chiari I malformation. CSF spaces and CSF flow are mildly diminished at the foramen magnum. Brain parenchyma appears otherwise unremarkable. 2. Dedicated spine imaging may be considered to assess for syrinx. 