48 years, Male, possible parkinsonism, gait difficulty. Question of hypoxic brain injury during birth. Per chart, patient also has history of recent fall with bruising on neck and back. Brain: No appreciable area of gliosis or volume loss to suggest prior ischemic injury. Mild hypoplasia of the inferior cerebellar vermis is suspected. Mild volume loss is also noted involving the cerebellar hemispheres. There is possible T1 hyperintensity along bilateral frontal dura which may be artifactual versus related to mineralization; finding is of doubtful clinical significance but can be correlated with prior CT if available. No corresponding signal abnormality is appreciated on the T2 or FLAIR sequences. There is no intracranial mass or mass effect. No focal parenchymal signal abnormality. No evidence of infarct or hemorrhage. No intracranial mass or mass effect. No hydrocephalus. No extra-axial collections. No volume loss, focal lesions, or abnormal iron deposition is evident within the basal ganglia, brainstem, or cerebellum. Major flow-voids are preserved. Trace mucosal thickening is evident in the paranasal sinuses. Calvarium and remainder of the extracranial soft tissue structures are unremarkable. Cervical spine: Some of the cervical spine sequences are motion degraded slightly limiting evaluation. There is mild edema involving the posterior soft tissues at the C5-C6 level at the level of the interspinous and supraspinous ligaments. Anterior and posterior longitudinal ligaments as well as ligamentum flavum demonstrate no disruption or signal abnormality. Vertebral body heights and alignment are maintained. Craniovertebral junction also appears within normal limits. The cervical spinal cord has normal signal characteristics and overall morphology. No evidence of hematoma within the spinal canal.There is mild congenital narrowing of the cervical spinal canal with pedicle hypoplasia and superimposed mild degenerative changes as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Mild congenital narrowing of the spinal canal with superimposed thickening of the ligamentum flavum and small disc bulge. Mild left neural foraminal stenosis related to facet arthropathy and uncovertebral hypertrophy. No significant right neural foraminal narrowing.C4-5: Mild spinal canal stenosis related to congenital narrowing and superimposed mild disc bulge. There is moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy. C5-6: There is mild to moderate narrowing of the spinal canal on a congenital basis as well as superimposed disc bulge and ligamentum flavum thickening. There is moderate to severe right and moderate left neural foraminal stenosis related to uncovertebral hypertrophy.C6-7: Mild spinal canal narrowing. There is moderate to severe bilateral neural foraminal narrowing related to disc bulge and uncovertebral hypertrophy.C7-T1: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal narrowing related to facet arthropathy..The vertebral artery flow voids appear to be intact.
1. No imaging findings to suggest sequela of prior hypoxic-ischemic injury. No intracranial mass or mass effect. No focal lesions involving the basal ganglia, brainstem, or cerebellum are appreciated.2. Mild volume loss involving the cerebellar hemispheres which is nonspecific and may be related to chronic antiepileptic medications for example. Mild hypoplasia involving the inferior cerebellar vermis also suspected.3. Images of cervical spine demonstrates mild edema involving the posterior soft tissues at the C5-C6 level which may represent mild ligamentous injury involving the interspinous and supraspinous ligaments at C5-C6. The anterior and posterior longitudinal ligaments and ligamentum flavum are intact. No cord signal abnormality, evidence of fracture, or hematoma within the spinal canal.4. Congenital narrowing of the cervical spinal canal with superimposed degenerative changes. There is up to mild to moderate spinal canal stenosis at the C5-C6 level. Relatively mild spinal canal narrowing at additional levels without cord signal abnormality. There is also high-grade neural foraminal stenosis at multiple levels. Please see details above.