Acute onset quadriparesis. Evaluate for meningeal inflammation or cervical cord compression. MRI brain:Motion limited exam. Small foci of restricted diffusion are visualized in the posterior periventricular regions bilaterally as well as a somewhat larger focus in the right parietal parenchyma compatible with acute ischemic infarcts. Additional foci of restricted diffusion are also visualized within the brainstem pons suspicious for acute ischemic infarct here. There was restricted diffusion on the previous exam from a week ago in posterior circulation distribution. No evidence of mass effect, midline shift or herniation. There is diffuse punctate susceptibility abnormality located throughout the brain most likely representing hemosiderin deposition. The differential includes amyloid angiopathy or changes related to chronic hypertensive encephalopathy. Much less likely are multiple hemorrhagic metastases or numerous cavernous malformations. Assessment for enhancement is severely limited secondary to patient motion. The ventricles and basal cisterns are normal in size and configuration. The major cerebral flow voids are intact. The orbits, skull and scalp soft tissues are grossly unremarkable. Bilateral mastoid fluid is likely secondary to intubation.MRI cervical spine:Motion limited exam. There is reversal of the cervical curvature and multilevel degenerative changes with grade 1 anterolisthesis of C2 on C3 and C3 on C4. Diffuse edema is seen in the cord beginning in the lower medulla, extending throughout the cervical spinal cord and including the visualized upper thoracic spinal cord. Although there are multilevel degenerative changes in the cervical spine, there is no evidence of acute cord compression. The cervical vertebral bodies are appropriate in height. Degenerative changes in the cervical spine are as described below:C2-3: There is a disc osteophyte complex and facet hypertrophy resulting in mild left neural foraminal stenosis. There is no right neural foraminal or central canal stenosis. C3-4: There is a disc osteophyte complex with uncovertebral and facet hypertrophy which causes mild to moderate right and moderate left neural foraminal stenosis. No central canal stenosis. C4-5: There is a disc osteophyte complex with right greater than left uncovertebral hypertrophy and facet hypertrophy. This causes severe right and moderate left foraminal stenosis with mild central canal stenosis.C5-6: There is a disc osteophyte complex with right greater than left uncovertebral hypertrophy as well as facet hypertrophy. This causes moderate right and mild to moderate left neuroforaminal as well as mild central canal stenosis.C6-7: There is a disc osteophyte complex with right greater than left uncovertebral hypertrophy with moderate to severe right and mild-to-moderate left neural foraminal stenosis. There is no central canal stenosis.C7-T1: No disc bulge. Mild facet hypertrophy but no neural foraminal or central canal stenosis.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1.Restricted diffusion in the posterior periventricular region bilaterally, right parietal parenchyma and brainstem pons are compatible with acute ischemic infarcts. Multiple small infarcts were noted on the recent previous MRI from a week ago also in a posterior circulation distribution.2.There is diffuse punctate susceptibility abnormality most concentrated within the parietal regions likely representing hemosiderin deposition. The differential most likely includes amyloid angiopathy or changes related to chronic hypertensive encephalopathy.3.Diffuse spinal cord edema beginning with the lower medulla, extending throughout the cervical spine and Including the visualized upper thoracic spine, without enhancement. No evidence of acute cord compression. The differential of cord edema is nonspecific including ischemic, inflammatory or neoplastic etiologies.4.Multilevel degenerative changes of the cervical spine which cause at most mild central canal stenosis at the C5-6 level and severe right neural foraminal stenosis at the C4-5 level. Additional degenerative changes are as described.