PMC3814995_01
A preoperative T1 sagittal spin echo MRI of the brain shows a Chiari I malformation with tonsillar descent beyond the level of the C1 lamina and syringomyelia and syringobulbia with dilation throughout the cervical spinal cord and no evidence of hydrocephalus
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F1
Her initial workup included an MRI of the brain and cervical spine, which showed a Chiari I malformation with tonsillar descent beyond the level of the C1 lamina and syringomyelia and syringobulbia with dilation throughout the cervical spinal cord and no evidence of hydrocephalus [Figure 1].
T1 sagittal MRI of the brain (a) and T2 sagittal MRI of the cervical spine (b) obtained on postoperative day one, which shows cerebellar prolapse
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F2
Postoperative MRI revealed a suggestion of an acute infarct of the right inferior vermis and otherwise normal postoperative changes [Figure 2].
T2 axial FLAIR MRI (a) and apparent diffusion coefficient MRI (b) and diffusion MRI (c) at postoperative day 5, upon return with new onset left sided weakness, demonstrating no acute infarcts
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F3
She underwent an MRI that showed bilateral acute infarcts of the cerebellar vermis [Figure 3].
Diffusion Weighted Imaging (DWI) (a) and T2 axial FLAIR MRI (b) on postoperative day 9 showing increased signal in the bilateral frontal and parietal lobes, consistent with PRES
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F4
A follow-up MRI revealed diffuse bifrontal and parietal gray matter hyperintensity on FLAIR without changes on diffusion-weighted imaging consistent with PRES and suggestive of edema from hypoxic ischemic changes secondary to prior seizure [Figure 4].
T2 axial FLAIR MRI demonstrating continuing hyperintensity of the right cerebellar vermis (a) and resolution of the right parietal increased signal one week after cessation of hypertensive therapy (b) (postoperative day 14)
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F5
Follow-up MRIs demonstrated progressive resolution of the cerebral edema and FLAIR signal [Figure 5] with complete resolution at 2 years postoperative [Figure 6].
(a and b) T2 axial FLAIR MRI 2 years after surgery showing complete resolution of changes associated with PRES
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F6
Follow-up MRIs demonstrated progressive resolution of the cerebral edema and FLAIR signal [Figure 5] with complete resolution at 2 years postoperative [Figure 6].
Sagittal T1 image 4 years postoperatively showing marked reduction in cervical syrinx and cerebellar prolapse
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F7
Her 4 year follow-up MRI demonstrates resolution of her syringomyelia [Figure 7].