Headache, back pain, and lower extremity weakness. History of IV drug use and HIV. Brain: There is no evidence of abscess, intracranial hemorrhage, or acute infarct. There are a few scattered foci of nonspecific T2 hyperintensity in the cerebral white matter. There are small globular extra-axial areas of low T2 and high T1 signal with susceptibility effect along the frontoparietal convexity, adjacent to the superior sagittal sinus. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is a partially empty sella. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, paranasal sinuses, and scalp soft tissues are grossly unremarkable.Lumbar Spine: There is no evidence of epidural abscess in the lumbar spine. There has been interval evolution of the bone marrow signal in the L4 and L5 vertebrae, with predominantly fatty marrow characteristics. There is extensive irregularity of the inferior L4 and superior L5 endplates. There is minimal fluid signal within the intervening disc space. There is underlying degenerative spondylosis at L4-5 and L5-S1, with mild bilateral L4-5 neural foraminal stenosis and at least moderate bilateral L5-S1 neural foraminal stenosis, but no significant spinal canal stenosis. There has been interval evolution of the bone marrow signal in the left sacrum and iliac bone, with predominantly fatty marrow characteristics and persistent irregularity of the left sacroiliac joint. The lumbar spine alignment is nearly anatomic. The imaged portions of spinal cord and cauda equina appear unremarkable.
1. No evidence of intracranial abscess or acute infarct. Small globular extra-axial areas of low T2 and high T1 signal with susceptibility effect along the frontoparietal convexity, adjacent to the superior sagittal sinus may represent dural ossification versus less likely subarachnoid hemorrhage. A head CT may be useful for follow up. 2. Sequela of prior discitis-osteomyelitis at L4-5 with considerable irregularity of the adjacent endplates, but no evidence of epidural abscess.3. Degenerative spondylosis at L4-5 and L5-S1, with mild bilateral L4-5 neural foraminal stenosis and at least moderate bilateral L5-S1 neural foraminal stenosis, but no significant spinal canal stenosis. 4. Sequela of prior left sacroiliitis.