75 years, Female, headache, falls. Stroke? Subdural?. Patient also has neck pain, question myelopathy. Brain: There are extensive patchy areas of T2/FLAIR hyperintensity in the bilateral subcortical and to a lesser degree periventricular white matter, which are nonspecific, but may be related to advanced chronic small vessel ischemic disease. Small chronic lacunar infarcts are also evident including the right caudate nucleus, left thalamus, left pons, and left cerebellar hemisphere. There is also mild to moderate degree of global parenchymal volume loss. There are multiple foci of susceptibility effect in the bilateral cerebral hemispheres which are predominantly in a peripheral lobar distribution. Multiple foci more centrally are also evident including the thalami. Major flow-voids are preserved. There is a punctate focus of hyperintensity in the left parietal lobe on the diffusion-weighted sequence with a relatively larger area of FLAIR hyperintensity and elevated ADC surrounding this region. No restricted diffusion to suggest acute ischemia in the remainder of the brain. No intracranial mass or mass-effect. No extra-axial collections. The ventricles are within normal limits in size and configuration. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are grossly unremarkable.Cervical spine: Craniovertebral junction alignment is maintained. There is retroodontoid soft tissue without associated spinal canal stenosis. There is mild edema involving the dens as well as right lateral mass of C1. There is also fluid at the left C1-C2 articulation. These findings may be on a degenerative or chronic inflammatory basis but if there is suspicion for recent trauma, CT may better assess for bony disruption in this region.The cervical vertebral bodies are appropriate in height. Alignment is grossly maintained with only minimal C6 on 7 retrolisthesis and minimal C7 on T1 anterolisthesis. No suspicious osseous lesions.There is no definite cord signal abnormality with motion degradation limiting evaluation.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Disc osteophyte complex with uncovertebral hypertrophy and ligamentum flavum thickening. There is mild to moderate spinal canal stenosis. There is moderate bilateral neural foraminal stenosis. C4-5: Disc osteophyte complex with uncovertebral hypertrophy and ligamentum flavum thickening. There is mild spinal canal stenosis. There is moderate left and mild to moderate right neural foraminal stenosis.C5-6: Disc osteophyte complex with uncovertebral hypertrophy and ligamentum flavum thickening. There is mild to moderate spinal canal stenosis including ventral indentation of the cord. No definite cord signal abnormality. There is moderate to severe bilateral neural foraminal stenosis.C6-7: Small disc osteophyte complex with uncovertebral hypertrophy and ligamentum flavum thickening. There is mild spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal. There is mild bilateral neural foraminal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. Extensive T2/FLAIR hyperintensity in the subcortical and periventricular white matter which is nonspecific but may be related to moderate to severe chronic small vessel ischemic disease. Multiple small chronic lacunar infarcts are also evident.2. Punctate focus of diffusion hyperintensity in the left parietal lobe as described above suspected to represent a tiny recent infarct adjacent to an area of chronic ischemia.3. Numerous foci of chronic microhemorrhage, which are nonspecific but given the predominant peripheral distribution, suggest amyloid angiopathy as an etiology. Additional foci such as in the thalami may be related to chronic hypertension.4. Moderate degree of multilevel degenerative changes in the cervical spine with mild to moderate spinal canal stenosis from the C3-C4 to C6-C7 levels. There are also multilevel neural foraminal stenoses. Additional details of individual levels as above. No definite cord signal abnormality.5. Bone marrow edema involving the C1 and C2 level which may be on a degenerative or chronic inflammatory basis. There is no significant prevertebral edema, however, sequela of prior trauma is not entirely excluded and CT can better assess for possibly underlying fracture if clinically indicated. Ligamentous structures are intact.