67 years, Female, new gait instability, cerebellar symptoms. Evaluate for evidence of CVA. Prior aneurysm clipping. Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Again seen are postsurgical changes of right frontotemporal craniotomy for prior aneurysm clippings. There is associated susceptibility artifact which slightly limits evaluation of the adjacent parenchyma. There is linear T2/FLAIR signal abnormality involving the right frontal lobe extending from the cortex into the right frontal periventricular white matter which may represent chronic infarct or postsurgical change and also evident on multiple prior CT studies. Brain parenchyma is otherwise unremarkable for age. Left internal carotid artery aneurysm is better assessed on recent CT study. Paranasal sinuses and mastoid air cells are clear. Bone marrow signal is within normal limits.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign with T2 hyperintensity involving the C3 and C4 vertebral bodies which is likely on a degenerative basis. There is abnormal T2 hyperintensity involving the bilateral aspects of the cervical cord at the C3-C4 level. Remainder of the cervical cord is unremarkable.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: There is a large right paracentral disc protrusion which along with ligamentum flavum thickening contributes to moderate to severe spinal stenosis with mild deformity of the cord related to compression. There is abnormal T2 hyperintensity as mentioned above. There is moderate to severe right and mild to moderate left neural foraminal stenosis. There is also right-sided facet arthropathy. There is a subcentimeter cystic structure anterior to the right facet joint which may represent a synovial cyst or perineural cyst.C4-5: Small disc osteophyte complex and ligamentum flavum thickening with mild narrowing of the spinal canal. There is mild to moderate bilateral neural foraminal stenosis. There is bilateral facet arthropathy, worse on the right. C5-6: Small disc osteophyte complex without significant spinal canal stenosis. There is mild bilateral, left greater than right, neural foraminal stenosis.C6-7: Small disc osteophyte complex without significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal stenosis related to uncovertebral hypertrophy.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits. There are small nodules involving the right thyroid lobe.
1. Postsurgical changes related to aneurysm clipping. There are mild chronic small vessel ischemic changes as well as small focus of encephalomalacia in the right frontal lobe which may be postsurgical. Brain parenchyma is otherwise unremarkable for age. Left ICA aneurysm is better assessed on recent CTA.2. Moderate to severe spinal canal stenosis at the C3-C4 level related to disc protrusion and ligamentum flavum thickening. There is abnormal signal involving the cervical cord at this level which is suspected to represent edema from compressive myelopathy.3. Multilevel neural foraminal stenoses, as detailed above, worst at the right C3-C4 level.