65 years, Male, recent fall, looking without CVA. Patient also has back pain and leg weakness.. Brain: MRI of the brain is within normal limits for age. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size. There is mild global parenchymal volume loss which is appropriate for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mild to moderate mucosal thickening throughout the paranasal sinuses, particularly the left frontal sinus, bilateral anterior ethmoid air cells, left maxillary sinus, and left sphenoid sinus. There is evidence of prior endoscopic sinonasal surgery including bilateral partial ethmoidectomies, uncinectomies, and middle turbinectomies.. Bone marrow signal and extracranial soft tissues are within normal limits. Lumbar spine: Numbering is performed as on prior MRI with transitional lumbosacral anatomy including 6 lumbar type nonrib-bearing vertebrae. There is a mild chronic compression fracture involving the L2 vertebral body, predominantly on the left and not appreciably changed in the interval. There a Schmorl's node involving the inferior endplate as before. Minimal superior endplate deformity involving the L3 vertebral body is also not significant changed. No edema at these levels. There is T1 shortening involving the marrow of the lumbar spine and pelvis compatible with prior radiation. No new or enlarging destructive osseous lesions are seen. Conus is in normal position.At L1-L2, there is a stable left paracentral to far lateral disk protrusion. There is minimal left foraminal narrowing. Spinal canal and right neural foramen are patent.At L2-L3, there is no significant change in left paracentral and foraminal disk protrusion with slight encroachment upon the left lateral recess. The descending left L3 nerve root may be impinged as before. There is mild bilateral facet arthropathy and ligamentum flavum thickening. There is mild to moderate left foraminal narrowing. Central spinal canal and right neural foramen are patent.At L3-L4, there is a small central annular fissure. There is bilateral facet arthropathy and ligamentum flavum thickening. No spinal canal or neural foraminal stenosis.At L4-L5, there is a mild disk bulge with left foraminal and extraforaminal annular fissure. There is mild-moderate right foraminal narrowing. There is also mild left neural foraminal narrowing with contact of the left exiting L4 nerve root. Bilateral facet arthropathy and ligamentum flavum thickening is noted.At L5-L6, there is uncovering of the disk related to minimal retrolisthesis with a mild disk bulge with right foraminal/far lateral prominence, which abuts the exiting right L5 nerve root as well as the descending nerve root in the right lateral recess. There is bilateral facet arthropathy and ligamentum flavum thickening. Overall moderate right foraminal narrowing. No significant central spinal canal stenosis or left neural foraminal narrowing.At L6-S1, there is no significant disk pathology or stenosis.
1. Brain parenchyma is within normal limits. Specifically, no evidence of acute infarct.2. Mild to moderate scattered paranasal sinus opacification as described above.3. Mild chronic compression fracture involving the L2 vertebral body remains unchanged since 4/23/2015. Minimal chronic compression fracture of L3 vertebral body is also unchanged. No new or enlarging destructive osseous lesions.4. Multilevel degenerative changes are also not appreciably changed since 4/23/2015. There is no significant central spinal canal stenosis at any level. There is multilevel neural foraminal stenosis as detailed above but not significantly changed in the interval.