Male, 55 years old, with transverse myelitis. Assess for MS. Brain:A few nonspecific T2 hyperintensities are seen in the periventricular white matter, most prominently adjacent to the left ventricular atrium. A nonspecific focus of T2 hyperintensity is also seen within the right pons.No evidence of restricted diffusion is seen. No parenchymal edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.Bone marrow signal characteristics are unremarkable. Incidental note is made of two subcentimeter cutaneous nodules along the left face.C-spine:A mild reversal of the normal cervical lordosis is seen. Alignment is otherwise unremarkable. Vertebral body height and morphology are preserved. No evidence of concerning marrow replacement or marrow edema is detected.The spinal canal is slender, most notably between C3 and C5, which is at least partially congenital but with some contribution from disk osteophyte formation and PLL thickening.The cervical spinal cord is also slender and demonstrates patchy parenchymal T2 hyperintensity beginning approximately at the C2-3 level and continuing down to at least C5-6.C2-3: Facet hypertrophy, right side more than left. Mild posterior disk osteophyte formation. No significant spinal canal stenosis. Mild right foraminal narrowing.C3-4: Facet hypertrophy. Mild posterior disk osteophyte formation. Mild spinal canal stenosis. Mild to moderate bilateral foraminal narrowing. C4-5: Posterior disk osteophyte formation, asymmetric to the right. Mild to moderate spinal canal stenosis with particular effacement of the right lateral recess. Moderate to severe bilateral foraminal narrowing. C5-6: Thickening of the PLL between C4-5 and C5-6. Posterior disk osteophyte formation, asymmetric to the left. Moderate spinal canal stenosis with particular effacement of the left lateral recess. Severe bilateral foraminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing. T-spine:Spinal alignment is anatomic. Vertebral body height and morphology are unremarkable. No concerning marrow replacement or marrow edema is detected.Again, the spinal canal is diffusely congenitally narrowed.The visualized spinal cord shows no evidence of any definite or convincing signal alteration.At T5-6, there is a small left paracentral/foraminal disk protrusion, in conjunction with left costovertebral joint hypertrophy.At T8-9 and T9-10, there are small central disk protrusions.At T10-11, there is a mildly bulging disk.At none of the above levels is there any evidence of cord impingement or significant spinal canal stenosis. Foraminal narrowing is suspected bilaterally at T10-11 and T11-12.At L1-2, a bulging disk and right paracentral disk protrusion, along with posterior element hypertrophy, contribute to produce a moderate generalized spinal canal stenosis with some crowding of the cauda equina. The neural foramina are mildly narrowed.
1. A few scattered small T2 hyperintense lesions are detected within the brain. These lesions are nonspecific, and while demyelinating disease may be considered, numerous additional etiologies could also produce this appearance.2. Patchy T2 signal abnormality is evident within the parenchyma of the cervical spinal cord involving the region from C2-3 down to C5-6. The cord does not appear edematous, and if anything, there seems to be some volume loss. Sequela of chronic demyelination could certainly be considered, and with the relative lack of specific findings in the brain, both MS and NMO would be in the differential. However, additional etiologies might include myelomalacia from chronic spinal canal stenosis, as well as sequelae of prior infectious or inflammatory conditions.3. Spinal canal stenosis is seen at several levels in the cervical spine, which reflects a congenitally slender spinal canal with superimposed disk osteophyte complexes and perhaps some PLL thickening.4. Aside from relatively mild degenerative disk findings, no significant abnormalities are detected in the thoracic spine.5. Disk degeneration at L1-2, just barely visualized on this examination, results in at least moderate spinal canal stenosis.