72 years Female (DOB: 6/19/1943)Reason: 72 year old with AML, concern for AML in spinal fluid and brain vs stroke, please eval History: neurologic deficits; right sided weaknessPROVIDER NAME: ANDRZEJ J JAKUBOWIAK MICHAEL J THIRMAN MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells demonstrate partial opacification of the right mastoid air cells. The visualized portions of the orbits are intact.There is a diffuse marrow replacement throughout the visualized calvarial and skull base structures.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine. There is diffuse marrow replacement throughout the visualized spine. There is multilevel disc desiccation presentThere are enlarged lymph nodes present within the jugular chains superior and supraclavicular regions.At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C5-6 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C6-7 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this level.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine. There is diffuse marrow replacement throughout the thoracic vertebrae.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is partial lumbarization of the S1 segment.. S1 represents a transitional vertebra The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine. There is multilevel disc desiccation present. There is diffuse marrow replacement throughout the lumbar vertebrae.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is mild anterior subluxation of L5 on S1 associated with a diffuse disc bulge and mild facet hypertrophy.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is mild disc bulge at this level associated with ligamentum flavum hypertrophy.At L3-4 there is no significant compromise to spinal canal or neural foramina. There is mild disc bulge at this level associated with ligamentum flavum hypertrophy.At L2-3 there is no significant compromise to spinal canal or neural foramina. There is mild disc bulge at this level associated with ligamentum flavum hypertrophy.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.There is diffuse marrow replacement throughout the calvarium, skull base and spine which is compatible patient's diagnosis of multiple myeloma.2.There is neck lymphadenopathy present.3.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 4.There are some mild degenerative changes present in the lumbar spine without significant compromise to spinal canal or neural foramina.5.There are mild degenerative changes present in the cervical spine.