Wk 6, Case 3 - Review

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Report

Patient History
27 year-old Female with acute worsening of chronic migraines for past week

Findings
These images demonstrate cerebellar tonsils which extend below the level of the foramen magnum with packing. The tonsillar descent measures approximately 10 mm. There is ventricular dilatation bilaterally with relative absence of the septum pellucidum. The optic nerves appear small in size. However, the optic chiasm is normal appearance. Diffusion weighted scans show no evidence of acute infarction.The cerebral aqueduct is not well visualized on the sagittal scan. It may be obstructed. On the CSF pulsation studies there is no flow through the aqueduct. It is narrowed.

Impressions
Chiari I malformation.

Absence of the septum pellucidum with optic nerve hypoplasia raising the possibility of septo-optic dysplasia. Clinical correlation is required.Ventricular enlargement without transependymal CSF flow affecting lateral and third ventricles but sparing fourth ventricle.

Aqueductal stenosis with obstruction.

Case Discussion

Faculty

David M Yousem, MD, MBA

Professor of Radiology, Vice Chairman and Associate Dean

Johns Hopkins University

Joshua P Nickerson, MD

Associate Professor of Neuroradiology

Oregon Health & Science University

Francis Deng, MD

Assistant Professor of Radiology and Radiological Science

Johns Hopkins University School of Medicine

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Wk 6, Case 3 - Review