78-year-old male with a gait disorder and traumatic SAH and question of NPH. MRI brain: There is susceptibility effect along the right anterior lateral temporal convexity and frontotemporal operculum compatible with prior subarachnoid hemorrhage as seen on CT. There is also evidence of trace subdural hematoma along the right frontotemporal convexity without mass effect and probably present on prior CT although difficult to appreciate due to its size.Again demonstrated is moderate periventricular and subcortical white matter T2/FLAIR hyperintensity which is nonspecific but likely related to chronic small vessel ischemic disease. No evidence of acute infarct. There is lateral ventricular and focal areas of sulcal prominence which appear slightly disproportional to the degree of volume loss and could indicate a communicating hydrocephalus/NPH pattern. There is no abnormal parenchymal or meningeal enhancement aside from along the right cerebral convexity which may be reactive to the trace subdural hematoma. No intracranial mass or mass effect. There is no midline shift or herniation. The major cerebral flow voids are intact. There is minimal scattered paranasal sinus mucosal thickening and a right maxillary sinus mucus retention cyst.MRI C-spine:The craniovertebral junction appears within normal limits. The cervical spine alignment is maintained and the cervical vertebral bodies and disc spaces are appropriate in height. The bone marrow signal is within normal limits. 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.Interspace observations:C2-3: Mild right greater than left facet hypertrophy. No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex which contacts the ventral cord. Mild facet arthropathy with mild left neuroforaminal narrowing. No right neuroforaminal narrowing or spinal canal stenosis.C4-5: Small disc osteophyte complex which contacts the ventral cord. Mild facet arthropathy. Mild left neuroforaminal narrowing. No right neuroforaminal narrowing or significant spinal canal stenosis.C5-6: Disc osteophyte complex which mildly indents the ventral cord and ligamentum flavum thickening contributing to minimal spinal canal narrowing. Mild left greater than right facet and uncovertebral hypertrophy. Mild/moderate left neural foraminal narrowing. No right neural foraminal narrowing.C6-7: Mild facet hypertrophy and ligamentum flavum thickening. No significant compromise to the spinal canal or neural foramina.C7-T1: No significant compromise to the spinal canal or neural foramina.
1.Trace subarachnoid and subdural hemorrhage along the right frontotemporal convexity grossly similar to prior CT allowing for slight differences in technique. No intracranial mass or abnormal enhancing lesions.2.Ventricular enlargement which appears slightly disproportional to the degree of volume loss and raises possibility of communicating hydrocephalus/NPH in the appropriate clinical setting.3.Moderate chronic small vessel ischemic disease.4.No cord signal abnormality or significant spinal canal stenosis in the cervical spine at any level.5.Multilevel degenerative changes in the cervical spine with small disc osteophyte complexes at multiple levels which contact the ventral cord. There is however no significant spinal canal stenosis overall at any level or cord signal abnormality. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.