 BRAIN MRI: The posterior fossa has a small capacities and the cerebellar tonsils display pointed morphologies and extend up to 15 mm inferior to the foramen magnum with crowding of the foramen magnum, which is unchanged. There is effacement of the basal cisterns. There is no evidence of cerebral edema, intracranial mass lesions, acute infarction, or intracranial hemorrhage. There is mild prominence of the clival epidural venous plexus, which may be due to engorgement from altered hemodynamics at the craniocervical junction. There is also minimal diffuse prominence of dural enhancement. The ventricles are unchanged in size and configuration, without evidence of ventriculomegaly or ventricular collapse. There is mild mucosal thickening of the right ethmoid air cells, scattered opacification of the left ethmoid air cells, and minimal mucosal thickening of the right frontal sinus. There is mild mucosal thickening of the right maxillary sinus with air-fluid level and a mucus retention cyst in the left maxillary sinus. There is fluid within the upper aerodigestive track as well. The mastoid air cells are clear. The orbits and extracranial soft tissues are unremarkable. CERVICAL SPINE: There is mild expansion and high T2 signal intensity diffusely within the central spinal cord extending from the C2/C3 level to the upper thoracic level, beyond the field of view. At the C2/C3 level, there is also a distinct punctate focus of T2 signal intensity in the anterior right aspect of the spinal cord with CSF signal characteristics, suggestive of cavitation. The vertebral column alignment is within normal limits. The vertebral body and disc space heights are preserved. The vertebral bone marrow signal is unremarkable. There is no significant spinal canal stenosis. There are small bilateral pleural effusions.BRAIN MRV: There is evidence of dural venous sinus thromboses.BRAIN MRA: There is no evidence of significant steno-occlusive lesions or aneurysms.NECK MRA: There is no evidence of significant steno-occlusive lesions.
1.Markedly low-lying cerebellar tonsils with crowding of the foramen magnum and effacement of the basal cisterns, as well as a small posterior fossa may represent an underlying Chiari 1 malformation with superimposed effects of intracranial hypotension manifesting as hindbrain herniation. However, no cerebral edema or intracranial mass is identified. 2.Long segment edema in the imaged portion of the central spinal cord may represent a spinal cord infarct in the setting of coagulopathy and hypoxia or presyrinx state related to the hindbrain configuration. Follow up via a complete spine MRI with diffusion-weighted imaging may be useful for further evaluation.3.No cerebrovascular arterial steno-occlusive disease or evidence of dural venous thrombosis.Findings discussed with Dr. Mikhal, neuro ICU resident on call by Dr. McCann at 4:45 PM on 5/13/2015.