Findings
Sagittal T2 image(1) shows defect in the posterior arch of the upper dorsal vertebrae(confirmed in sagittal GRE image-2). Herniation of the thecal sac and neural elements is seen through the defect and forming a sac posterior to it. Sagittal T1 image shows no fat signal component and axial T2 images show the posterior arch defect with the herniated sac. Overall features are suggestive of myelomeningocoele. Also noted is cerebellar tonsillar herniation with mild herniation of the medulla oblongata and inferior aspect of 4ᵗʰ ventricle as seen in images 1 and 3.
Diagnosis
Chiari-II malformation.
Summary
Cerebellar tonsillar herniation and spinal dysraphism are frequently diagnosed together and if one of them is diagnosed, the other finding should always be looked for. Apart from this MRI Brain is also suggested to look for supratentorial ventriculomegaly and callosal dysgenesis.
Further reads
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