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4b - Answer: A case of Chiari malformation for spinal cord evaluation

David Yousem MBA, MD
David M Yousem, MBA, MD
Professor of Radiology, Vice Chairman and Associate Dean
Includes DICOM files

Learn more about this case by reading the case report below. Additional instruction is provided in the Case Summary section of the course.

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Case Report

HISTORY: Chiari malformation. Evaluate cord.

TECHNIQUE:

MR images of the cervical dated 10/19/2016 were submitted for second opinion consultation on 12/5/2016.

COMPARISON: None.

FINDINGS:

MRI cervical spine 10/19/2016: There is inferior displacement of the cerebellar tonsils by approximately 6 to 7 mm below the plane of the foramen magnum, with a pointed appearance, compatible with Chiari malformation.

Extensive multiloculated T2 hyperintensity with expansion of the cord at C1-2 through the T1 level compatible with hydromyelia.

At C2-3, there is no posterior disc abnormality. There is no spinal canal or neural foraminal narrowing.
At C3-4, there is no posterior disc abnormality. There is circumferential effacement of the CSF space secondary to expansion of the cord related to the pharynx. There is no neural foraminal narrowing. At C4-5, there is a posterior disc extrusion contributing to moderate spinal canal narrowing with flattening of the cord. There is uncovertebral and facet hypertrophy resulting in moderate bilateral neural foraminal narrowing.
At C5-6, there is mild disc bulging with left greater than right uncovertebral hypertrophy and mild bilateral facet arthropathy. There is mild spinal canal narrowing. There is severe left and mild right neural foraminal narrowing.
At C6-7, there is diffuse disc bulging. There is bilateral uncovertebral hypertrophy and mild bilateral facet arthropathy. There is mild to moderate right and mild left neural foraminal narrowing. There is mild spinal canal narrowing.
At C7-T1, there is no posterior disc abnormality. There is no spinal canal or neural foraminal narrowing.

There is mild prominence of the submandibular ducts bilaterally, however they're symmetric.

IMPRESSION:

MRI cervical spine 10/19/2016: Chiari I malformation with multiloculated hydromyelia extending from C1-2 through C7-T1. Superimposed degenerative changes result in moderate spinal canal narrowing at C4-5.

LESSON 2, TOPIC 12

Case Challenge: Spine MRI Cases - I-MED Study

Content reviewed: May 12, 2022