 BRAIN: There is a region of T2 signal abnormality centered in the dorsal pons but extending inferiorly into the medulla, and superiorly into the midbrain with mild expansion. This area demonstrates patchy internal enhancement. There is no definite leptomeningeal enhancement within the brain. There is no acute infarct. There is mild persistent crowding at the foramen magnum without evidence of Chiari I malformation.CERVICAL: Although the findings are subtle, there is very likely mild bilateral scattered nerve root enhancement in the cervical spine. There is a small somewhat linear focus of T2 signal hyperintensity in the cervical cord on the right at C3, and an additional somewhat linear focus on the left at C6. No convincing pathologic enhancement is seen in the cord. There is enhancement and high T2 signal in the left superior articulating facet of C4 probably representing a hemangioma. Minimal degenerative findings in the cervical spine are unchanged from the prior recent MRI.
Stable signal abnormality with ill-defined enhancement in the brainstem, and additional lesions in the cervical cord without enhancement. Additionally, there is likely subtle enhancement of some of the cervical nerve roots. These findings are nonspecific, and the differential diagnosis again includes infectious diseases including atypical or viral etiologies, granulomatous, post-infectious and autoimmune etiologies. A neoplastic etiology is felt to be unlikely.