53-year-old male with seizures, neck pain and right arm weakness. MRI HEAD: There is no restricted diffusion to suggest ischemia. Scattered periventricular and subcortical punctate T2/FLAIR hyperintense foci which do not demonstrate restricted diffusion consistent with chronic small vessel ischemic disease. There is prominence of sulci for patient's age suggestive of volume loss. No midline shift or mass effect. No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma. Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus. The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. Chronic fracture of the right lamina papyracea as seen on prior CT's. MRI CERVICAL SPINE: There is artifact related to spinal hardware including interbody fusion at C5-C6, laminectomy at C4-C7 with evidence of instrumented posterior fusion. There is slight accentuation of the normal cervical lordosis. The spinal cord is normal in signal intensity with no evidence of spinal cord compression. There is no marrow edema. At C1-C2 there is no evidence of significant neuroforaminal or spinal cord stenosis. There is a focal well-circumscribed high T1/T2 signal lesion which likely represents a benign hemangioma along the base of C2.At C2-C3 there is mild left neuroforaminal narrowing related to uncovertebral hypertrophy There is no significant neuroforaminal stenosis on the right. There is no spinal canal stenosis.At C3-C4 there is disc osteophyte formation and associated mild stenosis of the spinal canal. There is mild right and moderate left neuroforaminal narrowing.At C4-C5 there is disc osteophyte formation. There is mild right and left neuroforaminal narrowing. No significant spinal canal stenosis.At C5-C6 there is mild right and at least mild left neuroforaminal narrowing. There is no significant spinal canal stenosis. At C6-C7 there is no significant spinal canal or neuroforaminal narrowing.At C7-T1 there is no significant spinal canal or neuroforaminal narrowing.
1. Chronic small vessel ischemic disease with no focal intraparenchymal hemorrhage or mass lesion. Mild prominence of the sulci for patient's age suggestive of volume loss.2. Postoperative changes in the cervical spine with multilevel degenerative changes and associated neuroforaminal narrowing as described above. There is mild spinal canal stenosis at the C3-C4 level but no evidence of cord compression.