Female, 81 years old, with dissection, headache, temporal pain. Evaluate for ischemia. MRI brain:No restricted diffusion is seen. Scattered small foci of T2 hyperintensity are seen within the cerebral hemispheres. No edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. Ventricular size and morphology are within normal limits. The cerebellar tonsils are noted to be low-lying given that they descend as much as 5 mm below the foramen magnum.MRA brain:No significant intracranial vascular stenosis or occlusion is seen. No aneurysm or vascular malformation is suspected.MRA neck:Mild atherosclerotic narrowing is seen at the right carotid bifurcation. No evidence of significant stenosis by NASCET criteria is seen in either carotid distribution. The origins of great vessels are patent.Again seen is an area of narrowing with the suggestion of extrinsic compression affecting the right vertebral artery at the C3-4 level. More distally, an area of narrowing is also redemonstrated affecting the V3 segment on the right just prior to its passing intracranially. Please note that fat-suppressed T1 precontrast images were inadvertently omitted.MRI C-spine:Alignment is anatomic. Vertebral body heights are preserved allowing for endplate irregularity. No evidence of pathologic marrow replacement or marrow edema is seen. The spinal cord is impinged at the C3-4 level due to degenerative findings, discussed more fully below. However, no areas of abnormal spinal cord signal are observed. No evidence of pathologic enhancement is seen.C2-3: Unremarkable. C3-4: Facet arthropathy. Posterior disc-osteophyte complex formation with ligamentum flavum thickening. Moderate spinal canal stenosis with slight flattening of the ventral spinal cord. Moderate bilateral foraminal narrowing. Of note, no specific cyst or mass is evident to account for the apparent narrowing and mass effect on the right vertebral artery. C4-5: Facet arthropathy. Posterior disc-osteophyte complex formation asymmetric to the left paracentral zone. Mild spinal canal stenosis with slight flattening of the left ventral cord. Mild left foraminal narrowing. C5-6: Facet arthropathy. Posterior disc-osteophyte complex formation and ligamentum flavum thickening. Mild spinal canal stenosis with minimal flattening of the ventral cord. Moderate to severe left foraminal narrowing. C6-7: No spinal canal stenosis or neuroforaminal narrowing. C7-T1: No spinal canal stenosis or neuroforaminal narrowing.
1.No evidence of acute ischemia is seen intracranially. There are findings compatible with mild chronic microvascular ischemic disease. The cerebellar tonsils are low-lying which is likely an incidental finding.2.No significant vascular compromise is detected intracranially. No definite aneurysm or vascular malformation is seen.3.Narrowing of the distal right V3 segment is seen correlating with findings on prior CTA. No additional information is obtained on this examination to support the possibility of a dissection at this site.4.Again seen is focal narrowing of the right vertebral artery at the C3-4 level. No obvious cyst or mass is demonstrated to account for this finding.5.Multilevel disc degeneration is seen. The C3-4 level is most severely affected where there is a moderate spinal canal stenosis and some degree of cord impingement. No cord edema is observed. Mild narrowing of the spinal canal is also evident at C5-6.