70 years, Female, numbness and tingling in left arm, known early stage lung cancer. Also decrease in left hand grip. Brain: There is no intracranial mass or abnormal parenchymal or meningeal enhancement to suggest metastatic disease. Multiple foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as in the pons, which are nonspecific, but compatible with mild-to-moderate chronic small vessel ischemic disease. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Calvarium and extracranial soft tissues are grossly unremarkable.Cervical spine: Examination is moderately motion degraded. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign. No suspicious enhancement is seen within the cervical spine. The cervical spinal cord has normal signal characteristics and overall morphology. Epidural mass in the thoracic spine with leftward displacement of the cord is better assessed on recent MRI from 2/13/2016.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: No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex. No significant spinal canal stenosis. There is mild left neural foraminal stenosis related to uncovertebral hypertrophy.C5-6: Small disc osteophyte complex. No significant spinal canal stenosis. Mild bilateral neural foraminal narrowing.C6-7: Small disc osteophyte complex. No significant spinal canal stenosis. There is mild to moderate bilateral neural foraminal narrowing.C7-T1: Small disc osteophyte complex No significant compromise to the spinal canal. Mild right and moderate left neural foraminal narrowing. There is linear increased enhancement/vascularity involving the epidural space and neural foramen on the left, and possibly related to the left-sided foraminal stenosis. No associated nodularity or thickening to suggest a neoplastic etiology.Paraspinous soft tissue structures appear within normal limits.
1. No evidence of intracranial metastatic disease.2. Mild to moderate chronic small vessel ischemic disease.3. Multilevel degenerative changes in the cervical spine which are suboptimally assessed due to motion degradation. There is however no significant spinal canal stenosis at any level or cord signal abnormality. There are varying degrees of mild to moderate neural foraminal narrowing which are detailed above. Linear enhancement/vascularity at the left C7-T1 level is most likely on a benign basis. No associated nodularity or thickening to suggest a neoplastic etiology.4. No evidence of metastasis to the cervical spine. Enhancing epidural mass involving the upper thoracic spine with leftward displacement of the cord is partially imaged and better assessed on recent thoracic MRI from 2/13/2016.