Female, 34 years old, with bilateral upper extremity weakness and dysphagia. Diffuse central T2 hyperintensity is seen within the visualized cervical spinal cord beginning at the C2 level. As noted on prior examinations, the posterior fossa is crowded with a tapered appearance of the cerebellar tonsils which appear to herniate below the foramen magnum.Straightening of the cervical lordosis is likely positional. Sagittal alignment is unremarkable. Vertebral body height and morphology are within normal limits. No evidence of marrow replacement or edema is seen. The spinal canal is congenitally slender. Only minimal disc degeneration is seen which causes no significant spinal canal or foraminal stenosis.
Diffuse abnormal signal affects the central portion of the spinal cord beginning at C2 and continuing throughout the remainder of the visualized spinal cord. In the absence of other specific findings, the differential diagnosis is broad and would include infectious, postinfectious or autoimmune phenomena, as well as ischemia. This abnormality could also potentially be related to altered CSF dynamics in the context of Chiari I malformation. A malignant process is felt to be unlikely though definitive evaluation would require postcontrast imaging.