Neurofibromatosis type II. Altered mental status and weakness. This examination was obtained at the completion of the brain/whole spine examination from the day prior which was not completed for the spine due to patient intolerance. The examination is mildly limited by motion/breathing artifact.There are changes of previous suboccipital decompression and intracranial neurofibromatosis type 2 stigmata. Please refer to the brain MRI report from the day prior for details.CERVICAL SPINE:The central, contrast-enhancing lesion involving the cervical spinal cord at C1-C2 level has not changed. The associated surrounding edema-like T2 signal is improved now extending from C1 level to just above the C2-C3 disc level, previously reaching below the C2-C3 level. Associated cord expansion is also mildly improved.Alignment is anatomic. Multilevel cervical disc desiccation is minimally increased. Disc-osteophyte complexes minimally indent the anterior aspect of the thecal sac at C2-C3 and C3-C4 levels but without significant spinal canal stenosis. There is mild left C3-C4 and C4-C5 foraminal stenoses by uncovertebral arthropathy. There is no suspicious marrow abnormality.THORACIC SPINE:Axial images are limited due to artifact. There is partial anterior fusion between T11 and T12 associated with mild but focal scoliosis, which is probably congenital and unchanged since the previous examination. This is associated with minimal central disc protrusion indenting the ventral thecal sac and ventral cord. Otherwise, the intervertebral disc are preserved in height and T2 signal. Alignment is preserved and marrow signal shows no suspicious focality. There is no signal or morphologic abnormality of the thoracic spinal cord.A 3 mm intradural extramedullary contrast-enhancing nodule on the right side of the spinal cord at T11-T12 level is not significantly changed since May 2011 examination. A 6 mm nodule left anterolateral to the spinal cord at T12-L1 level was also present previously but was not included on the axial images though appears grossly unchanged. Multiple other smaller lesions are present also on sagittal imaging, with suggestion of similar lesions also on the previous examination.LUMBOSACRAL SPINE:As described on the MRI brain/posterior spine report from yesterday, there is transitional spinal anatomy with 6 lumbar appearing vertebrae. For the purposes of this exam, the last fully formed disc is at L5-L6 with a rudimentary disc at L6-S1. Please note that the spine was numbered in a different manner on the prior exam from March 2010 .Axial images are limited due to artifact. Numerous contrast enhancing intradural extramedullary masses are present along the cauda equina nerve roots. Similar appearance was present on the previous MRI from March 2010 though accurate lesion-to-lesion comparison cannot be performed given the degraded nature of the previous postcontrast sequence caused by motion.There is asymmetric convex fullness and contrast enhancement in the right L5-L6 neural foramen. Similar finding is present along the included sacral nerve roots as well, more pronounced on the right. These may have increased since the previous examination but the previous axial postcontrast images were obtained without fat saturation.Lumbar spinal alignment is anatomic. Vertebral bodies are normal in height. Please refer to the MRI report from yesterday for other lumbar spine findings. There are mild opacities at the lung bases dependently, likely atelectasis.
1.The contrast enhancing component of an expansile intramedullary lesion at C1-C2 level has not changed but the surrounding T2 hyperintense signal and mild cord expansion are slightly improved since May 2011.2.Numerous intradural, extramedullary contrast-enhancing lesions in the lumbar and thoracic regions are not grossly changed since the previous examinations from May 2011 and March 2010 although accurate, lesion-to-lesion comparison cannot be performed given the different nature of the examinations and motion degradation. 3.Asymmetric fullness and increased contrast enhancement involving the sacral nerve roots, more on the right, may have slightly progressed since the previous examination from March 2010 and may represent schwannomas.4.Please refer to the brain and total spine MRI reports from the day prior for details regarding the other findings. Please note that transitional spinal anatomy is present in the surgery is to be contemplated, correlation with imaging of entire spine is recommended.