Male, 78 years old, with altered mental status and bacteremia. Evaluate for abscess, source of infection. Brain:No evidence of restricted diffusion is seen. Confluent and patchy periventricular T2 hyperintensity is demonstrated. No edema or mass effect is detected. No evidence of intracranial hemorrhage or any abnormal extra axial fluid collection is seen. The ventricles and sulci are slightly prominent compatible with underlying parenchymal volume loss. Postcontrast images are limited by motion artifact, but no definite pathologic enhancement is seen. The mastoid air cells are opacified.Lumbar spine:For the purposes of numbering, the last fully formed disc space will be designated L5-S1. The L5 vertebral body demonstrates transitional morphology.Postoperative findings are seen consistent with laminectomy at L3 and L4. Heterogeneous fluid and/or debris is evident within the operative bed. The margins of the operative bed are enhancing. The posterior paraspinal soft tissues are also edematous and enhancing, particularly on the left.Sagittal spinal alignment is grossly anatomic. Vertebral body heights are preserved. Scattered Schmorl's node deformities and degenerative endplate signal abnormality are seen. Otherwise, no concerning marrow replacement is evident.The visualized distal spinal cord, conus and nerve roots of the cauda equina are unremarkable. No definite pathologic intrathecal enhancement is observed.L1-2: Bulky left lateral osteophyte formation is seen. No significant spinal canal stenosis. Moderate left foraminal narrowing. L2-3: Facet arthropathy. Ligamentum flavum thickening. Disc bulging with bulky left anterolateral osteophyte formation. Mild to moderate spinal canal narrowing. Moderate bilateral foraminal narrowing. L3-4: Postoperative changes. Facet arthropathy. Bulging disc with a right foraminal protrusion. Mild to moderate spinal canal narrowing. Severe right foraminal narrowing with possible nerve root impingement. Moderate left foraminal narrowing. L4-5: Postoperative changes. Facet arthropathy. Mild to moderate spinal canal narrowing is seen, to which bulging of the fluid in the resection bed contributes. Severe right foraminal narrowing with probable nerve root impingement. Moderate to severe left foraminal narrowing. L5-S1: Facet arthropathy. No significant spinal canal or foraminal stenosis.
1.No acute intracranial abnormality or specific infectious source is identified in the head. There are findings which likely reflect chronic microvascular ischemia.2.Postoperative findings are seen compatible with laminectomy at L3-4. The operative bed contains fluid and demonstrates marginal enhancement. This appearance is nonspecific and while the possibility of infection cannot be excluded on the basis of imaging alone, these findings are also within acceptable limits in the recent postoperative period.3.Multilevel disc and posterior element degeneration is seen. Mild to moderate spinal canal narrowing is demonstrated at L2-3, L3-4 and L4-5. In addition, severe foraminal narrowing is evident on the right at L3-4 and on the right at L4-5.