Clinical question: Evaluate for NMO or demyelinating disease. Signs and symptoms: BUE weakness. Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2 -- C3 demonstrate moderate disk disease and loss of disk height and mild facet and moderate ligamentum flavum hypertrophy changes. Constellation of changes results in moderate to severe central spinal stenosis and no neural foraminal compromise.C3 -- C4 demonstrate moderate advanced disk disease and loss of disk height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. There is resultant significant central spinal and bilateral neural foraminal compromise.C4 -- C5 demonstrate advanced disk disease and loss of disk height, mild ligamentum flavum and moderate facet hypertrophic changes are present at this level. Constellation of changes results in moderate central spinal stenosis, significant left and moderate right neural foraminal compromise.C5 -- C6 demonstrate moderate disk disease and loss of disk height, mild facet and ligamentum flavum degenerative changes. No spinal stenosis or neural foraminal compromise.C6 -- C7 demonstrate moderate disk disease and mild facet and ligamentum flavum degenerative changes without spinal stenosis. Mild right neural foraminal compromise is present.C7 -- T1 demonstrate mild disk disease and moderate left facet and ligamentum flavum hypertrophy. There is resultant mild to moderate left neural foramina compromise and patent right and without spinal stenosis.The signal intensity and caliber of the cervical cord and uppermost visualized thoracic cord is within normal.Pre-and post-enhanced brain MRI:Examination demonstrates few nonspecific and non-enhancing foci of flair hyperintensity only in the subcortical white matter of bilateral cerebral hemispheres. Unremarkable signal intensity brain parenchyma otherwise on all acquired MRI sequences. Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and brain myelination otherwise. Unremarkable images through posterior fossa.Negative post enhanced images of the brain parenchyma, leptomeninges, calvarium and the orbits.Unremarkable images through the orbits.Normal pneumatization signal pattern of all paranasal sinuses and bilateral mastoid air cells and middle ear cavities.
1.Normal signal intensity of cervical and uppermost visualized thoracic cord. Extensive degenerative changes of cervical spine results in multilevel mild to severe central spinal stenosis at C2 -- C3, C3 -- C4 and C4 -- C5 levels. There are multilevel neural foraminal compromise as detailed per level above.2.Pre-and post enhanced brain MRI demonstrates few nonspecific and nonenhancing small foci of flair hyperintensity only in the subcortical white matter of cerebral hemispheres. Unremarkable exam otherwise.