35yoMale presents with complaints of headache, and neck pain. On physical exam cerebellar symptoms (unsteady gait, difficulty with finger to nose), lower brainstem findings (dysarthria, dysphagia), and central cord symptoms (hand weakness, cape anesthesia) are noted. During exam cranio-cervical hypermobility is also noted. Imaging options will include CT or MRI. Imaging will show herniation of cerebellar tonsils, and syringomyelia.