Clinical question: Evaluate for pathology. Signs and symptoms: Bilateral clonus on exam. Nonenhanced total spine MRI:Examination demonstrates normal signal intensity and anatomical alignment of the vertebral column. Examination of cervical spine demonstrate a small disc extrusion at C4-C5 which results in complete effacement of ventral subarachnoid space and subtle flattening deformity of the cord. No evidence of central spinal stenosis. There is however suspected increased T2 signal intensity of the cord on sagittal T2 STIR series 501 image 8. This needs to be further evaluated with dedicated complete MRI of cervical spine. This study was recommended however patient was unwilling to continue with the study and refused.There is normal signal intensity and caliber of the cervical- thoracic cord as well as conus and cauda equina otherwise.No evidence of central spinal stenosis at any level. There is an isolated ligamentum flavum hypertrophy at T2 level.Unremarkable visualized paraspinal soft tissues.
1.No evidence of mass effect on the cord or central spinal stenosis.2.Small disc protrusion at C4-C5 with effacement of ventral subarachnoid space as detailed. Suspicious tiny focus of cord increased T2 signal intensity at this level. Correlate with neurological exam and consider follow-up with a dedicated cervical MRI.3.Asymmetric prominent ligamentum flavum hypertrophy at T2 and unremarkable exam otherwise.