Bilateral arm and neck pain (right arm also extremely tender with tingling pain). Also, hyperreflexia in the legs. Clinical suspicion for compressive or demyelinating c-spine disease versus brain process. Brain:There is a moderate burden of scattered/patchy T2 hyperintensity in the frontoparietal white matter. The temporal white matter is very mildly involved. This is not associated with diffusion restriction, or susceptibility effect or abnormal contrast enhancement. There is no involvement of the juxtacortical white-matter or of the corpus callosum, which shows preserved morphology, volume and signal characteristics. The brainstem and cerebellum are also spared. The lesions are not associated with brain volume loss. The CSF-containing spaces are normal in size. There is no mass affect, midline shift or herniation. There is no intracranial hemorrhage. The major intracranial vessels are patent.The orbits are normal. The right maxillary sinus is small and shows osseous wall thickening and minimal mucosal thickening which may reflect chronic sinusitis. The paranasal sinuses and the mastoid air cells are clear.Cervical Spine:Cervical alignment is notable for minimal reversal of the normal lordosis, which may relate to patient position. Vertebral body heights are preserved. Marrow show no suspicious focality, accounting for degenerative change adjacent to the endplates, most pronounced at C6-C7. The cervical spinal canal is diffusely, congenitally small. In addition, degenerative disease at multiple levels contribute to the narrowing which is most pronounced at C5-C6 as described below. There is no abnormal signal is the spinal cord.C2-C3: There is mild canal narrowing by disc-osteophyte complex which is slightly more pronounced on the left. There is moderate right and mild left foraminal narrowing by uncovertebral/facet arthropathy.C3-C4: There is moderate spinal canal narrowing by disc-osteophyte complex. There is mild right and left neural foraminal narrowing by uncovertebral/facet arthropathy. Dorsal annular fissure.C4-C5: There is moderate spinal canal narrowing by disc-osteophyte complex. There is mild-to-moderate left and minimal right neural foraminal narrowing by uncovertebral/facet arthropathy.C5-C6: The disc-osteophyte complex has a central disc protrusion component moderately narrowing the spinal canal and mildly deforming the spinal cord. This is associated with moderate right neural foraminal narrowing caused by uncovertebral and facet arthropathy. The left neural foramen is not narrowed.C6-C7: Disc-osteophyte complex moderately narrows the spinal canal while uncovertebral/facet arthropathy cause moderate right worse than left neural foraminal narrowing.C7-T1: Disc-osteophyte complex cause no significant spinal canal narrowing. There is right worse than left moderate bilateral neural foraminal narrowing by facet/uncovertebral arthropathy.
1.Moderate patchy cerebral white matter abnormality is nonspecific and most likely related to moderate chronic small vessel ischemic disease. There are no specific features to suggest demyelination.2.Degenerative changes in the cervical spine with moderate spinal canal stenosis at C3-C4, C4-C5, C5-C6 (worst at C5-C6) with mild cord deformity. No cord signal abnormality. In addition, there is variable neural foraminal narrowing (moderate-to-severe). There are no findings to suggest demyelination. 