30 years, Male, Reason: history of aneurysm rupture, hydrocephalus, third VC, syrinx. History: new headaches, neck pain Brain MRI: Again seen are postoperative findings related to right PICA aneurysm clipping as well as suboccipital craniotomy for Chiari decompression. There is artifact related to the aneurysm clip, which obscures the surrounding anatomy. Again seen is encephalomalacia and susceptibility effect in the right frontal periventricular region and caudate head likely related to prior hemorrhage. T2/FLAIR hyperintensity in the right frontal subcortical white matter has increased since 5/11/2016 although similar to the increased hypoattenuation noted on CT dated 9/15/2016 when compared to 7/24/2016. This finding may represent increased gliosis and/or edema. Ventricles have increased in size as prior MRI from 5/11/2016 although not significantly changed since more recent CT from 9/15/2016 allowing for differences in technique. There is mild increase in T2/FLAIR hyperintensity, compared to prior MRI, in the periventricular region which may represent transependymal flow of CSF.A left transparietal ventricular shunt catheter again seen. Prior additional ventriculostomy tracts are also evident. There is no evidence of acute infarction. Susceptibility artifact related to aneurysm clip limits assessment for CSF spaces and flow dorsally at the foramen magnum; there is however grossly preserved ventral CSF space at the foramen magnum with suggestion of preserved biphasic flow ventrally. The prepontine cistern appears minimally smaller than on prior MRI.Brain MRA:There is nonvisualization of the right distal vertebral artery to the level of right vertebrobasilar junction related to aneurysm clip artifact.Remainder of the intracranial circulation including the bilateral ICAs, MCAs, ACAs and vertebrobasilar arteries appear to be otherwise patent. No appreciable aneurysm.Cervical and Thoracic Spine:There is no significant change in overall size of the cervicothoracic syrinx. For example the syrinx at the C1-C2 level measures 2 x 5 mm in the AP and transverse dimensions, not significantly changed. In the lower cervical cord the syrinx occupies the right aspect of the cervical cord as before and measures up to 3 x 6 mm at the at the C7-T1 level which is also not significantly changed.Significant motion degradation limits assessment of the thin syrinx extending through the thoracic cord. There is however no gross evidence to suggest interval enlargement.Unchanged reversal of cervical lordosis. Moderate degree of thoracic scoliosis with apex at approximately the T8 level is again noted and better assessed with standing radiographs. There is no significant spinal canal stenosis at any level. Bone marrow signal is benign.
1. Compared to prior brain MRI from from 5/11/2016 there has been increase in dilatation of the ventricular system, although not significantly changed compared to more recent CT from 9/15/2016. There is also increase in T2/FLAIR hyperintensity in the right subcortical frontal lobe compared to prior MRI, which may reflect increased gliosis and/or edema; this finding was also noted on more recent CT from 9/15/2016.2. No significant change in findings of Chiari decompression. CSF spaces and flow ventrally at the foramen magnum is grossly preserved. Evaluation of the dorsal foramen magnum severely limited due to artifact from aneurysm clip.3. Postsurgical changes compatible with history of prior PICA aneurysm clipping. The right distal vertebral artery cannot be assessed due to artifact and CTA may be useful to assess for stenosis or aneurysm in this region. Remainder of the intracranial circulation is patent.4. No significant change in extent of cervicothoracic syrinx.