Clinical question: History of enhancing abnormality in cervical spine. Signs and symptoms: Right arm/hand paresthesias; surveillance scan. Pre and post enhanced cervical MRI:Examination demonstrate an intramedullary right hemicord foci of T2 hyperintensity with evidence of subtle decreased cord caliber. There is questionable faint enhancement of this lesion. This finding is associated with subtle decreased cord caliber on this study which is new since prior exam and likely representing evolution of lesion into a more chronic state. Finding is highly suggestive of a inflammatory/demyelinating disease. Other possibilities of an infectious process or tumor is exceedingly unlikely. There is no convincing evidence of any additional foci of cord signal abnormality or abnormal enhancement.There is generalized smaller than expected caliber of the spinal canal is believed to be a congenital anatomical variation. Additionally diffuse posterior longitudinal ligament hypertrophy further contributes to decreased caliber of the spinal canal and spinal stenosis at C3-C4, C4-C5 and C5-C6 levels and to a lesser degree at C6-C7 level. This appearance has not significantly changed since prior study from 2-25-15.Degenerative disc disease at C3-C4 including a tiny central and right para median disc protrusion with enhancement is again noted. This finding also contributes to spinal stenosis at this level.Degenerative changes at C6-7 and a shallow left paramedian disc protrusion with enhancement also remains fairly similar to prior exam and with resultant subtle mass effect on the cord and contributing to central spinal stenosis.
1.Intramedullary right hemicord signal abnormality at C3-C4 disc level demonstrates interval subtle decrease cord caliber and with questionable faint enhancement. This finding most likely representing a focus of inflammatory/demyelinating process. Other differentials of primary cord tumor/lymphoma or an infectious process is considered extremely less likely. Further follow-up however is recommended. 2.Congenitally small size of cervical canal as well as diffuse posterior longitudinal ligament hypertrophy results in multilevel central spinal stenosis without significant change since prior exam.3.Degenerative disc disease at C3-C4 and a central and rightward small disc protrusion with enhancement demonstrated no significant change since prior exam and contributes to central spinal stenosis at this level.4.Degenerative changes at C6-C7 and including a shallow left paramedian faintly enhancing disc protrusion demonstrate no significant change.