68 years Female (DOB: 12/22/1947)Reason: Pt with 4-6 week hx of dizziness/lightheadedness, L leg weakness, numbness, spasticity, ? of urinary retention; rule out vessel occlusion, stroke History: Pt with 4-6 week hx of dizziness/lightheadedness, L leg weakness, numbness, spasticity, ? of urinary retention; rule out vessel occlusion, strokePROVIDER NAME: TAO XIE TAO XIE MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There are 7 mm enhancing lesions present in each internal auditory canal. These were not present on the exam from 10/20/2014. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.Incidental note is made of partial empty sella.The visualized portions of the paranasal sinuses demonstrate some minor mucosal thickening. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRA brain:Antegrade flow is present in the distal internal carotid arteries, the distal vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries.There is no evidence for intracranial aneurysm or cerebrovascular occlusion.The anterior communicating artery is identified and is medium size. The posterior communicating arteries are intact. The vertebral arteries are similar in size.MRA neck:There is opacification of the aortic arch, great vessels from the aortic arch and carotid arteries and vertebral arteries. There is no stenosis identified of the great vessels from the aortic arch. On the basis of NASCET criteria there is no significant stenosis at the carotid bifurcations. There is no significant stenosis along the course of the vertebral arteries. MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:There is diffuse leptomeningeal nodular enhancement throughout the thoracic spinal cordThe thoracic vertebral bodies are appropriate in the overall alignment and height. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine. There is a mild dextrocurvature to the thoracic spine.There is a 13 mm x 16 mm axial dimension well-circumscribed lesion along the posterior surface of the right lobe of the liver which does not enhance following contrast administration. It is bright on T2 and dark on T1 suggesting it is cystic.Lumbar spine:There is nodular enhancement present within the thecal sac along the conus medullaris, cauda equina and within the full-thickness of the thecal sac at the S2 level. There is enhancement following the sacral exiting nerve roots. There is nerve root enhancement along many of the nerve roots in the cauda equina.Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild ligamentum flavum hypertrophy at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.Findings suggest a lesions in the internal auditory canals bilaterally and symmetrically. Given the leptomeningeal enhancement within the spine this is most likely represents leptomeningeal enhancement. These were not present on the exam from 10/20/2014. Please correlate with clinical history. Given the fact that these lesions in the internal auditory canals did not exist in the 2014 exam schwannoma is unlikely.2.There is leptomeningeal disease predominantly involving the thoracic spinal cord, cauda equina and sacral exiting nerve roots. One possibility is that this represents leptomeningeal carcinomatosis. Other differential considerations include granulomatous disorder including sarcoid and tuberculosis. 