Diagnosis: Myoclonus Abnormal reflexClinical question: assess for cervical stenosis/myelopathySigns and Symptoms: gait impairment, hyperreflexia, H/O Sjogren syndrome MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eye lenses are thin.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. There is multilevel disk dessication present. A 7mm T2 hyperintense focus within the C2 vertebral body which enhance following gadolinium is stable since the prior exam.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. There are left sided uncovertebral osteophytes at this level associated with encroachment of the left exiting nerve roots. This is stable since the prior exam.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.
1.Mild degenerative changes in the cervical spine worse at C3-4 where there is mild to moderate encroachment of left sided exiting nerve roots. This is stable since the prior exam from 20132.C2 lesion is stable since the prior exam from 2013 and most likely benign.3.Several periventricular and subcortical white matter changes of a mild degree are nonspecific. They are likely of likely clinical significance.