Clinical question: Rule out spinal cord pathology. Signs and symptoms: 80-year-old female with weakness and hyperreflexia. Nonenhanced cervical MRI:Extensive degenerative changes of cervical spine mostly at C3-C4-C6/C7 levels are noted.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 moderate disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and mild facet disease as well as mild grade 1 anterolisthesis. There is also a left paramedian superiorly migrated extruded disc with resultant significant mass effect, flattening deformity and posterior displacement of the cord which in combination with degenerative changes results in significant central spinal stenosis. There is also significant right and moderate to significant left neural foraminal compromise. Additionally note is made of increased T2/FLAIR signal intensity within the cord at this level which extends inferiorly to at least mid C5 level and consistent with myelitis.C4-C5 demonstrate advanced disc disease and loss of disc height, moderate bilateral ligamentum flavum hypertrophy and facet degenerative changes. Shallow broad-based bulging disc and hypertrophic spur is also noted. Constellation of findings results in moderate central spinal stenosis and moderate to severe bilateral (left greater than right) neural foraminal compromise. Increased T2 signal intensity of the cord as mentioned above.C5-C6 demonstrate advanced disc disease and significant loss of disc height, mild to moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Findings results in moderate central spinal stenosis, significant left and moderate right neural foraminal compromise.C6-C7 demonstrate moderate disc disease and loss of disc height and moderate bilateral ligamentum flavum hypertrophy. Mild central spinal stenosis and moderate bilateral neural foraminal compromise is noted.C7-T1 demonstrates mild degenerative changes with resultant mild bilateral neural foraminal compromise and no spinal stenosis.Upper most visualized thoracic spine and thoracic cord is unremarkable.
1.Extensive degenerative changes of cervical spine with resultant multilevel significant to moderate central spinal stenosis at C3-C4, C4-C5 and C5-C6 levels as detailed above. An extruded and superiorly migrated disc on the left at C3-C4 as mentioned.2.Multilevel bilateral mostly significant neural foraminal compromise as detailed per level.3.Increased T2 signal intensity of the cord extending from C3 inferiorly to mid C5 with decreased cord caliber consistent with myelitis.