Male, 73 years old, with right leg weakness and numbness, follow-up epidural hematoma. A T2 hyperintense, T1 intermediate collection is again seen within the dorsal epidural space at the L4-5 disc level with rim enhancement compatible with an epidural hematoma. On comparison with the prior examination, this collection is no larger and, in fact, may even be slightly decreased in size.As before, this collection contributes, along with a bulging disc and central disc protrusion as well as facet and ligamentum flavum hypertrophy, to a significant spinal canal stenosis which, again, is stable or perhaps mildly improved. There remains some degree of crowding of the cauda equina nerve roots at this level. Mild to moderate bilateral foraminal narrowing is seen, not significantly changed.No significant degenerative disc disease is seen from T12-L1 through L2-3. At L3-4, facet and ligamentum flavum hypertrophy and bulging disc along with prominence of the dorsal epidural fat contribute to a significant spinal canal stenosis and crowding of the cauda equina which are unchanged. Mild bilateral foraminal narrowing is seen.At L5-S1, facet hypertrophy, ligamentum flavum thickening and a bulging disc contribute to a mild generalized spinal canal stenosis. The right neural foramen is severely narrowed and the left neural foramen is moderately narrowed.The lumbar lordosis is straightened. A slight retrolisthesis of L3 relative to L4 is unchanged. No areas of concerning marrow signal abnormality are seen apart from patchy fatty replacement and fatty degenerative endplate change at L4-5.
1.An epidural hematoma dorsal to the thecal sac at L4-5 is stable to slightly decreased in size. There remains a significant spinal canal stenosis at this level with crowding of the cauda equina, though the degree of stenosis may also be slightly improved. Mild to moderate bilateral foraminal narrowing at this level is unchanged.2.A significant spinal canal stenosis is also unchanged at L3-4 secondary to disc degeneration and posterior element hypertrophy.3.Severe right neuroforaminal narrowing at L5-S1 is unchanged.