Clinical question: Left leg weakness x 3 weeks. Moderate low back pain. History of malignancies. Signs and symptoms: As above. Pre-and post-enhanced lumbar MRI:The signal intensity of vertebral column demonstrate changes related degenerative disk disease. There is also uniformly T1 hyperintensity of L5 and visualized S1 and S2 levels of cervical spine consistent with radiation changes.The signal intensity and caliber over the lower most visualized thoracic cord, conus and cauda equina is also within normal.Post enhanced images demonstrate no detectable abnormal enhancement the vertebral column, cord, leptomeninges or the cauda equina to suggest metastatic disease.T12 -- L1 is unremarkable.L1 -- L2 demonstrate mild degenerative changes are unremarkable otherwise. Incidental note at this level is made of severely atrophic right kidney. Multiple cystic like lesions within the large left kidney is noted.L2 -- L3 demonstrate mild disk disease and moderate bilateral ligamentum flavum hypertrophy and mild facet degenerative changes. Constellation of above changes results in mild to moderate central spinal stenosis and moderate bilateral neural foraminal compromise.L3 -- L4 demonstrate advanced degenerative disk disease and loss of disk height, moderate bilateral facet and ligamentum flavum hypertrophy and resultant significant central spinal stenosis with severe right and mild left neural foraminal compromise. Degenerative changes at this level also results in mild grade 1 anterolisthesis.L4 -- L5 demonstrate moderate disk disease and loss of disk height, moderate to severe right and moderate left facet and ligamentum flavum hypertrophy. Constellation of changes results in moderate central spinal stenosis and moderate left neural foramina compromise.L5 -- S1 demonstrate moderate disk disease and loss of disk height and asymmetric moderate left facet and ligamentum flavum hypertrophy. There is no central spinal stenosis. Mild to moderate left neural foraminal compromise is however noted.Pre-and post enhanced brain MRI:Negative diffusion weighted images.Flair and T2 weighted images demonstrate minimal small foci of periventricular and subcortical flair hyperintensity which are nonspecific however considering patient's stated age of 75 the often represent microvascular ischemic changes.Signal intensity and overall anatomical morphology of brain parenchymal otherwise remains within normal on all MRI sequences. The signal void of major intracranial arterial branches are identified.Post enhanced images demonstrate no detectable abnormal parenchymal or leptomeningeal enhancement.Unremarkable calvarium and orbits and without evidence of abnormal enhancement.There is normal pneumatization signal pattern of all paranasal sinuses and bilateral mastoid air cells and the middle ear cavities.
1.Pre-and post enhanced MRI of the lumber spine demonstrate no evidence of study disease. Marrow signal changes suggestive of prior radiation is noted at L5, S1 and S2. Extensive degenerative changes of the lumbar spine results in central spinal stenosis at L2 -- L3, L3 -- L4 and L4 -- L5 levels as detailed. Degenerative changes also results in neural foraminal compromise as detailed per level.2.Pre-and post enhanced brain MRI demonstrates findings suggestive of minimal chronic non-hemorrhagic small vessel ischemic strokes and unremarkable otherwise.