Clinical question: CCM? why the cyst and hemosiderin ring. Signs and symptoms: Hand 3 chest. Pre-and post-enhanced brain MRI:Negative diffusion weighted series.Examination demonstrates several punctate foci of flair hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres. Although the findings are nonspecific considering patient's stated age of 66 possibility of chronic microvascular ischemic changes should be considered. This finding is not associated with any hemorrhagic changes.There is a slight prominence of central cortical sulci for age. The signal intensity of brain parenchyma however remains reading normal otherwise on all MRI sequences.Post-enhanced images demonstrate normal abnormal enhancement the brain parenchyma, the meninges, calvarium or the orbits.The signal void of major intracranial arterial branches are identified.Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.Pre-and post-enhanced cervical MRI:Examination demonstrate a well demarcated T2/T2 stir hyperintensity intramedullary lesion measuring at 18 mm (cc) and 9 mm in (AP) centered at C6 level. The lesion results in expansion of the cord and significant effacement of subarachnoid space/spinal stenosis. There is subtle uniform enhancement of the lesion. There is extensive surrounding cord T2/T2 stir hypointensity consistent with hemosiderin deposition/staining. There is no evidence of T2 or flair hyperintensity surrounding the lesion to suggest cord edema or myomalacia. Constellation of findings are highly suggestive of a cavernoma.Examination in addition demonstrate extensive degenerative changes of cervical spine however maintained anatomical alignment.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate mild to moderate degenerative changes of the disk and the posterior elements. Additionally there is a prominent broad-based disk protrusion at this level. Constellation of findings of degenerative disease and larger disk protrusion results in mass effect, flattening and posterior displacement of the cord and moderate central spinal stenosis. There is inferior migration of disk fragment posterior to the body of C4 with associated mass effect and flattening deformity of the cord and central spinal stenosis as well. There is also moderate bilateral neural foraminal compromise. There is no convincing evidence of associated cord T2 hyperintensity at this level.C4 -- C5 mild disk disease and moderate bilateral facet hypertrophic changes and mild ligamentum flavum hypertrophy. There is a small broad-based disk protrusion also present at this level which results in flattening and posterior displacement of the cord and moderate central spinal stenosis. Moderate left and mild to moderate right neural foraminal compromise is present at this level.C5 -- C6 demonstrate degenerative changes with result in mild-to-moderate left and mild right neural foraminal compromise..C6 -- C7 demonstrate moderate bilateral ligamentum flavum hypertrophy and mild disk and facet disease. No spinal stenosis or neural foraminal compromise.C7 -- T1 is unremarkable with the exception of mild facet and ligamentum flavum hypertrophy.
1.Pre-and post-enhanced brain MRI demonstrates findings suggestive of mild chronic hemorrhagic small vessel ischemic strokes and unremarkable otherwise. Please see above comments.2.Pre-and post-enhanced MRI of the cervical spine demonstrate an intramedullary mass highly suggestive of a cavernoma measuring at 18 mm (cc) and 9 mm in AP with resultant expansion of the cord and central spinal stenosis as well as diffuse adjacent cord hemosiderin deposition/staining. Degenerative changes at C3 --C4 and a large disk protrusion at this level results in significant mass effect and flattening deformity of the cord and central spinal stenosis. There is inferior migration of disk fragment posterior to C4 level which also contributes to central spinal stenosis. Small central disk protrusion at C4 -- C5 results in moderate central spinal stenosis. Multilevel neural foraminal compromise of varying degrees (some significantly) as detailed per level.