82-year-old male with gait decline. Reevaluate for CNS demyelination to explain a left Babinski reflex. Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are is extensive periventricular and subcortical T2 hyperintensities, which are unchanged. There is mild diffuse volume loss. There is no abnormal intracranial enhancement. There is no midline shift or herniation. The major cerebral flow voids are intact. There is mild left maxillary sinus, left frontal and ethmoid air cell mucosal thickening. There is an underpneumatized right frontal sinus. The orbits, skull, and scalp soft tissues are grossly unremarkable. However, there is an enhancing nodule that measures up to 8 mm, which appears to arise from the posterior aspect of the deep right parotid gland. There is a small left nasopharyngeal retention cyst.Cervical Spine: The exam is limited by motion. The spinal appears unremarkable. The bone marrow signal is within normal limits. The vertebral body heights are preserved. There is no spondylolisthesis. At C2 and C3, there is a mild disc bulge, but no significant compromise to the spinal canal or neural foramina. At C4-5, there is a disc osteophyte complex with facet and right greater than left uncovertebral hypertrophy, which causes severe right and moderate to severe left neuroforaminal narrowing. There is mild spinal canal stenosis at the C4-5 level. At C5-6, there is a disc osteophyte complex, as well as left greater than right facet and uncovertebral hypertrophy, which contributes to severe left and moderate to severe right neural foraminal narrowing. There is mild spinal canal stenosis at this level. At C6-7, there is a disc osteophyte complex, as well as facet and uncovertebral hypertrophy, which contribute to moderate bilateral neural foraminal narrowing. There is mild spinal canal stenosis at this level. At C7-T1, there is a small disc osteophyte complex, but no compromise to the spinal canal or neuroforamina. There are small disc bulges at the T1-T2 and T2-T3 levels without compromise to the spinal canal or neuroforamina at these levels. The vertebral artery flow voids appear to be intact. The paraspinous soft tissue structures appear within normal limits.
1.No evidence of intracranial hemorrhage, mass, or acute infarct. 2.Extensive white matter lesions may represent chronic small vessel ischemic disease and/or demyelination.3.Multilevel degenerative spondylosis, which is most prominent at the C4-5 and C5-6 levels, where there is at most mild spinal canal stenosis and severe right C4-5 and severe left C5-6 neural foraminal narrowing.4. Nonspecific nodule that measures up to 8 mm, which appears to arise from the posterior aspect of the deep right parotid gland. I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.