Male, 47 years old, with right-sided hyperreflexia and weakness. Assess for cord compression versus nerve root compression. Brain:Diffusion-weighted images are within normal limits. A small linear focus of T2 hyperintensity is evident within the brainstem at the pontomedullary junction, actually best appreciated on sagittal spine views. No evidence of edema or mass effect is seen. No acute intracranial hemorrhage or any abnormal extra-axial fluid collection is detected. The ventricles are normal in size and morphology.C-spine:Spinal alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen.The visualized spinal cord shows normal signal intensity throughout. No epidural abnormalities are suspected.C2-3: No spinal canal stenosis or neuroforaminal narrowing. C3-4: Facet arthropathy is evident on the right. A small expansile cystic lesion noted on prior CT within the C4 superior articulating process is T2 hyperintense. Minimal posterior disc-osteophyte complex formation is seen. No significant spinal canal stenosis. Severe right foraminal narrowing with possible nerve root impingement. C4-5: Posterior disc-osteophyte complex formation asymmetric to the right paracentral zone which impinges upon and mildly deforms the spinal cord. No cord signal abnormality. Mild left foraminal narrowing. C5-6: Posterior disc-osteophyte complex formation with central focality which mildly impinges upon the spinal cord. No cord signal abnormality. Mild left foraminal narrowing. C6-7: Minimal posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: Facet arthropathy. No significant spinal canal or foraminal stenosis.
1.No acute lesions are evident in the brain. Note is made of a small T2 hyperintense focus within the brainstem at the pontomedullary junction for which there is no correlation on prior CTA. This finding is nonspecific and could reflect a small chronic ischemic lesion or gliosis from prior inflammation or injury.2.Multilevel cervical spondylosis is demonstrated in the cervical spine. This is most notable at C4-5 and C5-6 where disc osteophyte complexes also impinge upon the spinal cord. At C3-4, significant facet arthropathy is evident on the right with probable degenerative cyst formation. This results in a severe stenosis of the neural foramen and possible nerve root impingement.