45 years, Female, Reason: Pt with intermittent vertigo, HA, diplopia, incoordination; rule out cerebellar abnormality, MS, or lesions. Also hyperreflexia and neck pain. Brain: No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Few foci of T2/FLAIR hyperintensity are seen in the frontal subcortical white matter, which are nonspecific. There is a punctate focus of susceptibility in the left posterior temporal lobe subcortical white matter consistent with chronic microhemorrhage or calcification. Brain parenchyma is otherwise unremarkable for age. Developmental venous anomaly in the left cerebellar hemisphere is incidentally noted. No suspicious parenchymal or meningeal enhancement. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is a tiny mucous retention cyst in the left maxillary sinus. There is nonspecific prominence of the nasopharyngeal lymphoid tissue. Paranasal sinuses and mastoid cells are clear. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained aside from mild reversal of cervical lordosis which may be in part positional. Bone marrow signal is benign including T1 hyperintense lesions involving the T1 and T2 vertebrae compatible with hemangiomas or foci of fat. The cervical spinal cord has normal signal characteristics.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Tiny central disc protrusion which contacts the ventral cord. No significant compromise to the spinal canal or neural foramina.C4-5: Disc osteophyte complex with effacement of the ventral thecal sac and overall very mild spinal canal stenosis. There is also mild right neural foraminal stenosis. Left neural foramen is patent.C5-6: Disc osteophyte complex and uncovertebral hypertrophy with mild to moderate spinal canal stenosis. There is also mild to moderate right and mild left neural foraminal stenosis.C6-7: There are edematous endplate marrow signal changes and small Schmorl's node involving the superior C7 endplate. There is disc osteophyte complex and ligamentum flavum thickening. There is moderate degree of spinal canal stenosis at this level with mild cord contour deformity but without cord signal abnormality. There is moderate right and mild to moderate left neural foraminal stenosis. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.There is a partially imaged enlarged left thyroid nodule measuring at least 4 cm in the transverse dimension and 5.2 cm in the craniocaudal dimension.
1. Brain parenchyma is essentially unremarkable. No intracranial mass or mass effect. There are minimal foci of T2/FLAIR hyperintensity in the bifrontal subcortical white matter which are nonspecific and not particularly suggestive of demyelinating disease. There is also a single punctate focus of susceptibility, which may represent a chronic microhemorrhage or focus of punctate calcification, in the left posterior temporal lobe.2. No signal abnormality or abnormal enhancement in the cervical cord. There are multilevel degenerative changes with moderate spinal canal stenosis at the C6-C7 level and to a slightly lesser degree at the C5-C6 level. Additional levels as above.3. Large left thyroid nodule which can be further assessed with ultrasound as clinically warranted.