Male, 67 years old, with history of lower extremity weakness, evaluated at an outside hospital and given the diagnosis of Devic's disease, with subsequent weakness in the upper extremities as well as upper extremity spasms. Brain:A small cystic space in the white matter adjacent to the right frontal horn is seen with minimal if any surrounding T2 hyperintense signal.No discrete white matter lesions are seen in the brain. No evidence of parenchymal edema or mass effect is seen. The corpus callosum is intact and of normal thickness. No additional abnormal extra-axial collections are seen. The ventricles are within normal limits. Mild prominence of the sulci may reflect a variation of normal or mild parenchymal volume loss.Cervical spine:Images are degraded by motion artifact. Spinal cord T2 signal is inhomogeneous, but given the motion artifact, this cannot be definitively confirmed as true signal abnormality. The left aspect of the spinal cord seems to be slightly thinner than the rest (see image 17 of series 19).Spinal alignment is anatomic. Vertebral body heights are preserved. No worrisome marrow signal replacement seen.C2-3: No significant spinal canal or neuroforaminal stenosis. C3-4: Right facet hypertrophy. Posterior disc-osteophyte complex formation asymmetric towards the right foraminal zone. No significant spinal canal stenosis. Moderate right foraminal narrowing. C4-5: Posterior disc-osteophyte complex formation, asymmetric towards the right. Mild generalized spinal canal stenosis without significant impingement of the cord. Moderate to severe bilateral foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation. Ligamentum flavum thickening. Mild generalized narrowing of the spinal canal without severe cord impingement. Severe bilateral foraminal narrowing. C6-7: Facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal or foraminal stenosis. C7-T1: Unremarkable. Thoracic spine:Again, there is a mild fluctuation in signal intensity through the thoracic spinal cord, which may be artifactual rather than true signal abnormality. The spinal cord is otherwise unremarkable.Exaggerated thoracic kyphosis in. Spinal alignment is otherwise unremarkable. Vertebral body heights are preserved. No worrisome marrow signal abnormality is seen.Mild degenerative disc disease is evident without spinal canal or neuroforaminal stenosis is suspected.
1.Small cyst or perivascular space in the right frontal white matter. No white matter lesions are seen which would be consistent with a demyelinating etiology.2.Evaluation of the spinal cord is compromised by the presence of motion artifact. Inhomogeneity of the spinal cord T2 signal may therefore represent artifact versus true signal abnormality. There may be mild thinning of the left aspect of the cervical cord at some levels as discussed above. If these findings are indeed real, it is possible that a chronic underlying demyelinating process could have produced them, though the diagnostic certainty of this study is low.3.Scattered cervical degenerative findings are seen as above with areas of spinal canal narrowing but no high-grade canal stenosis or obvious cord impingement. Scattered foraminal narrowing ranges from moderate to severe.