Female, 75 years old, with worsening weakness. Evaluate for new CVA, neurosyphilis, demyelination. Brain:Patchy T2 hyperintensity is seen in the periventricular white matter with scattered small foci also evident in the basal ganglia and thalami and in the pons. The pattern and morphology of these lesions are nonspecific. No evidence of parenchymal edema or mass effect seen. No restricted diffusion is detected. There are no findings to suggest acute intracranial hemorrhage or any abnormal extra-axial fluid collections. No pathologic intracranial enhancement is seen. The ventricles and sulci are mildly and proportionately prominent compatible with underlying volume loss.C-spine:Alignment is anatomic. Vertebral body height and morphology are within normal limits. No evidence of marrow edema, replacement or pathologic enhancement is seen. The visualized spinal cord demonstrates normal signal intensity and morphology and is likewise free of pathologic enhancement. No epidural lesions are detected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Left facet arthropathy. Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. No foraminal narrowing. C4-5: Minimal posterior disc-osteophyte complex formation. No spinal canal stenosis. No foraminal narrowing. C5-6: No spinal canal stenosis or neuroforaminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.
1.Patchy white matter signal abnormality is seen, predominantly in the periventricular regions and to a lesser extent the basal ganglia, thalami and pons. The pattern and morphology of the lesions are nonspecific. Although demyelination is not excluded from the differential diagnosis, chronic small vessel ischemic disease would be a statistically more likely possibility.2.Mild degenerative findings in the cervical spine with no evidence of significant spinal canal or foraminal compromise. The spinal cord itself is within normal limits.