Male, 50 years old, status post lung transplant with distal arm sensory loss, altered sensorium with drowsiness, intermittent confusion and memory loss, word finding difficulty, dropping items. Brain:No evidence of restricted diffusion is seen. No edema or mass effect is detected. Numerous scattered foci of FLAIR hyperintensity are seen within the cerebral hemispheres, largely in a subcortical distribution. The pons is also affected by ill-defined FLAIR hyperintensity.No evidence of intracranial hemorrhage or any abnormal extra-axial fluid collection is seen. The ventricles are normal in size and morphology. The right cerebellar tonsil descends below the level of the foramen magnum by 5 6-mm. However, the foramen magnum does not appear to be particularly crowded.Cervical spine:Alignment is anatomic. Vertebral body heights are preserved. Degenerative endplate signal changes are seen, but there are no areas of concerning marrow replacement.Spinal cord morphology is altered by disc osteophytes at multiple levels as discussed below. However, no clear focal signal abnormality is detected within the cord. No epidural abnormalities are seen.C2-3: Facet arthropathy. Mild posterior disc-osteophyte complex formation which may just contact the ventral cord. No significant spinal canal or foraminal stenosis. C3-4: Facet arthropathy. Mild posterior disc-osteophyte complex formation which may just contact the ventral cord. No significant spinal canal stenosis. Mild bilateral foraminal narrowing. C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation which indents and deforms the ventral cord. Moderate generalized spinal canal stenosis. Moderate bilateral foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation which indents and deforms the ventral cord. Moderate to severe spinal canal stenosis. Moderate right and mild left foraminal narrowing. C6-7: Facet arthropathy. Posterior disc-osteophyte complex formation which indents and deforms the ventral cord. Moderate spinal canal stenosis. Moderate bilateral foraminal narrowing. C7-T1: Facet arthropathy. No significant spinal canal or foraminal stenosis.
1.No acute intracranial abnormality is seen. 2.There are numerous scattered foci of nonspecific FLAIR hyperintensity within the cerebral hemispheres and the pons. This could reflect chronic small vessel ischemic disease, vasculitis, sequelae of prior demyelination, or sequelae of some other inflammatory process. 3.Incidentally noted is a low-lying right cerebellar tonsil which does meet imaging criteria for a Chiari I malformation. However, the foramen magnum does not appear to be crowded.4.Multilevel disc osteophyte formation and posterior element degeneration is seen in the cervical spine. Significant spinal canal stenosis is evident at C4-5, C5-6 and C6-7 with some degree of cord impingement. No evidence of spinal cord edema is seen.