76 year old female with IPH. Evaluate for cervical fracture. Brain:There are postoperative findings related to left craniotomy. There is residual subdural blood product along the left hemisphere which is hyperintense on T1 and T2 weighted images and which was isoattenuating on the prior CT. This collection, likely representing subacute subdural blood, measures up to 10 mm in thickness similar to prior study. A more recent subdural hematoma along the left interhemispheric falx which demonstrates intermediate T1 signal and hypointense T2 signal measuring a maximum of 16 mm in thickness in the left occipital region is also unchanged from recent CT. Accounting for differences in technique, the left temporal parenchymal hematomas appear essentially identical to recent CT and the degree of vasogenic edema seems to be similar as well. There is generalized mass effect with effacement of the left lateral ventricle and right midline shift of approximately 5 mm, all unchanged. There is probably a small amount of layering blood product in the right occipital horn of the lateral ventricle which appears to have been present on prior study although was not as conspicuous at that time. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. There is persistent opacification of the right maxillary sinus with an air-fluid level. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Cervical Spine:Susceptibility artifact is seen related to orthopedic instrumentation which appears to be centered at C5/6 and C6/7 disk spaces. The spine alignment is straightened. The bone marrow signal is unremarkable. There is mild STIR hyperintensity within the soft tissues of the upper neck along the nuchal ligament. There is fluid along the oral cavity and hypopharynx which is likely related to ET tube placement. A congenital narrowness of the spinal canal is seen, with level specific degenerative changes as listed below: At C2-C3, there is no significant compromise to the spinal cord or neural foramina. At C3-C4, there is likely thickening of the posterior longitudinal ligament and suggestion of a central disk protrusion with no significant cord impingement. The neural foramina are patent bilaterally. At C4-C5, there appears to be thickening of the posterior longitudinal ligament or disk osteophyte formation and ligamentum flavum hypertrophy associated with significant narrowing of the spinal canal and what appears to be a chronic thinning of the cord. There is mild left neural foraminal narrowing.At C5-C6, there also appears to be thickening of the posterior longitudinal ligament or disk osteophyte formation which causes generalized spinal canal narrowing and also what appears to be chronic thinning of the cord. There is mild neural foraminal narrowing bilaterally. At C6-C7, there is mild generalized spinal canal and neural foraminal narrowing. At C7-T1, there is no significant compromise to the spinal cord or neural foramina.
1. Stable left temporal lobe parenchymal hematomas which are probably relatively acute given the MRI signal characteristics. 2. Stable acute to early subacute parafalcine subdural hematoma on the left. 3. Stable somewhat older likely subacute subdural hematoma along the left lateral temporal lobe. 4. There is stable generalized mass effect and midline shift. 5. There is minimal layering blood product within the right occipital horn. 6. There is evidence of prior surgery in the cervical spine. 7. There is congenital narrowing of the spinal canal which is exacerbated at several levels by either posterior longitudinal ligament thickening, disk protrusion, or la combination of both. The cord seems to be thinned chronically at these levels. 8. No definite trauma of the cervical spine. 