75 years, Male, altered mental status, posterior reversible encephalopathy syndrome. Neck pain, rule out stenosis. Brain: There is a focus of restricted diffusion involving the right post central gyrus and right parietal centrum semiovale. There is extensive T2/FLAIR hyperintensity in the bilateral cerebral hemispheres predominantly involving the periventricular and subcortical white matter of the bilateral frontal, parietal, and to a lesser degree temporal and occipital lobes. Small foci of FLAIR hyperintensity within the cortex also noted in the bilateral frontal lobes. Patchy FLAIR hyperintensity is also evident in the brainstem and bilateral cerebellar hemispheres. Multiple lacunar infarcts are also noted within the left greater than right basal ganglia and thalami. There is global parenchymal volume loss. No intracranial mass or mass effect. No midline shift or herniation. No hydrocephalus. There are multiple foci of susceptibility effect involving the basal ganglia, thalami, brainstem, and cerebellum with a distribution favored to be related to chronic hypertension. Additional scattered foci in the lobar distribution such as in the right frontal lobe and left parietal and occipital lobes may be related to amyloid angiopathy.Cervical spine:There is reversal of cervical lordosis centered at the C3-C4 level. Vertebral body heights are maintained. Bone marrow signal is benign. No obvious cord signal abnormality is evident although STIR sequence could not be obtained due to significant patient motion, there by limiting sensitivity for cord signal abnormality. Multilevel degenerative changes are seen which are suboptimally evaluated, individual levels as below:C2-3: No significant compromise to the spinal canal or right neural foramen. Mild left neural foraminal stenosis. C3-4: Disc osteophyte complex with moderate spinal canal stenosis. There is moderate to severe bilateral neural foraminal stenosis.C4-5: Disc osteophyte complex and ligamentum flavum thickening with moderate spinal canal stenosis and moderate bilateral neural foraminal stenosis, left worse in right.C5-6: Disc osteophyte complex and ligamentum flavum thickening. There is moderate spinal canal stenosis. There is moderate bilateral neural foraminal stenosis.C6-7: Small disc extrusion with mild spinal canal stenosis at this level. There is mild bilateral neural foraminal narrowing.C7-T1: Disc bulge without significant spinal canal stenosis at this level. There is mild left greater than right neural foraminal narrowing.
1. Small focus of acute infarct in the right parietal lobe.2. Extensive patchy supratentorial and infratentorial T2/FLAIR hyperintensity which is nonspecific and much of which may represent advanced chronic small vessel ischemic disease. Some of these areas (such as in the posterior fossa) may be reversible/indicative of PRES and can be confirmed with follow-up imaging.3. Multiple chronic microhemorrhages involving the basal ganglia, thalami, brainstem, and cerebellum likely related to chronic hypertension. Additional scattered foci of microhemorrhage in the lobar distribution such as in the right frontal lobe and left parietal and occipital lobes may be related to amyloid angiopathy.4. Cervical spine study is motion degraded but demonstrates moderate spinal canal stenosis at the C3-C4, C4-C5, C5-C6 levels. 5. Please note post contrast brain imaging could not be obtained due to significant patient motion. STIR sequence of the cervical spine could also not be obtained, thereby limiting evaluation for cord signal body. No cord signal abnormality is evident within these limitations.Dr. Ali discussed findings with Dr. Sheikh 1120 hrs on 12/8/2015.