HeadachePRES VS SVTCervical compression versus demyelination. Patient has neck pain and numbness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is an ill-defined focus of a contrast enhancement in the right pons measuring 14 mm in diameter which was seen on the prior exam which is identified on the susceptibility weighted imaging as a serpiginous signal voids. Most likely this represents capillary telangiectasia.There is a punctate T2 and FLAIR signal hyperintensity are present in the left external capsule anteriorly which has not changed since the prior examNo abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate partial opacification of the right sphenoid sinus which was also present on the previous exam. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina. There are perineural cysts present at this level just outside the neural foramina.There is a pseudoaneurysm present at the left vertebral artery at the level of the thecal sac at the atlanto-occipital level associated with approximately 50% stenosis at the distal left vertebral artery as it enters the thecal sac.
1.Capillary telangiectasia in the right pons is stable compared to the prior exam.2.There is a pseudoaneurysm present at the left vertebral artery at the level of the thecal sac at the atlanto-occipital level associated with approximately 50% stenosis at the distal left vertebral artery as it enters the thecal sac which is best seen on the recent CTA. Please refer to CTA of the same date for further comments.3.There are no stigmata of posterior reversible encephalopathy syndrome appreciated4.No evidence for compression of the cervical spinal cord