Melanoma and right arm weakness, concern for metastases. MRI brain:There is no evidence of intracranial mass or acute infarct. No abnormal intracranial enhancement is evident. There is cystic encephalomalacia in the bilateral frontal lobes in the periventricular region. A 5 mm focus of susceptibility artifact is noted in the anterior paramedian right frontal lobe (series 1701 image 109), which may be related to prior hemorrhage or mineralization. Confluent and scattered foci of T2/FLAIR hyperintensity in the periventricular and cortical white matter are nonspecific, but compatible with chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major intracranial vascular flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.MRI C-spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained. The cervical vertebral bodies and disc spaces are appropriate in height. There is a focus of T1 and T2 hyperintensity in the right side of the T1 vertebral body, compatible with intraosseous hemangioma. No focal worrisome bone marrow signal abnormality is identified. The cervical spinal cord has normal signal characteristics and overall morphology. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.There are mild multilevel degenerative changes, most prominent at C5-6. At C5-6, there is right greater than left uncinate hypertrophy contributing to mild right neural foraminal narrowing. There is also mild spinal canal narrowing at this level, predominantly on the developmental basis. No high-grade spinal canal stenosis or neural foraminal narrowing is identified in the cervical spine.
1. No evidence of intracranial or cervical spine metastatic disease.2. 5 mm focus of susceptibility in the anterior paramedian right frontal lobe which may be related to chronic hemorrhage or mineralization. No associated enhancement.3. Cystic encephalomalacia in the bilateral frontal lobes may be related to remote ischemia or other injury. Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are nonspecific and may represent chronic small vessel ischemic disease, prior inflammation, or less likely demyelination.4. Degenerative changes in the cervical spine without high-grade spinal canal or neural foraminal stenosis. 