Clinical question: Stroke, critical stenosis requiring surgery. Signs and symptoms: Right hemianopsia. Nonenhanced brain MRI:Diffusion weighted images demonstrate mildly restricted diffusion in the distribution of distal the left PCA in the left occipital lobe. This finding demonstrate flairand T2 weighted hyperintensity without hemorrhage or appreciable mass effect.Additionally examination demonstrate minimal periventricular and subcortical tiny foci of FLAIR hyperintensity which are nonspecific and nonhemorrhagic and could represent minimal chronic small vessel ischemic strokes. The findings are entirely in the subcortical and periventricular white matter and without detectable abnormality of the basal ganglia, thalami, pons or the cerebellum/vermis.Prominence of cortical sulci and cerebellar-vermian folia is detected however likely within normal range for patient's stated age of 86.The signal void of major intracranial arterial branches are identified.The signal intensity of the intracranial venous sinuses are unremarkable.Calvarium and soft tissues of the scalp are unremarkable.Unremarkable images through the orbits.All paranasal sinuses are visualized and unremarkable.On coronal T2-weighted images there is diffuse signal abnormality on the right mandibular condyle with internal foci of T2 hyperintensity. Review of prior head CT from 7-7-15 conference presence of cystic-like lesions in the right condyle suspected of subcortical cysts and degenerative disease. Correlate with clinical finding and consider follow-up with dedicated imaging.Findings and concerns on this exam were discussed by phone with Dr. Matthew Burn #1840 of neurology department at the time of review of exam.Nonenhanced brain MRA Patent and unremarkable bilateral vertebral arteries, bilateral height, branches, basilar artery and its distal branches.Patent and unremarkable visualized internal carotid arteries in the upper cervical, across the skull base and in their supraclinoid segments. Patent and unremarkable bilateral anterior and middle cerebral arteries and their branches.A right posterior communicating artery is identified and there is no detectable left posterior communicating artery which is an anatomical variation.Nonenhanced cervical MRI:Examination demonstrates extensive degenerative changes of cervical spine.Foramen magnum is unremarkable.C2-C3 demonstrate advanced disc disease with significant loss of disc height, mild facet and ligamentum flavum hypertrophy (left greater than right). Findings results in significant right neural foraminal compromise and mild central spinal stenosis.C3-C4 demonstrate advanced disc disease with significant loss of disc height, mild bilateral hypertrophic changes of the articulating facets and mild ligamentum flavum hypertrophy. Constellation of changes results in moderate central spinal stenosis and significant bilateral neural foraminal compromise.C4-C5 demonstrate advanced disc disease and loss of disc height, large ventral disc-osteophyte complex results in significant flattening and posterior displacement of the cord and significant central spinal stenosis. Significant bilateral neural foraminal compromise is also noted.C5-C6 demonstrate advanced disc disease, complete loss of disc height and fusion at the level of the disc. Finding results in mild central spinal stenosis and significant bilateral neural foraminal compromise.C6-C7 demonstrate advanced disc disease with complete loss of disc height and fusion at the level of this. Findings results in significant right and moderate to significant left neural foraminal compromise and no central spinal stenosis.C7-T1 demonstrate moderate to advanced disc disease and significant loss of disc height and mild hypertrophic changes of posterior elements. Constellation of changes results in significant left and mild right neural foraminal compromise and without central spinal stenosis.Examination demonstrate questionable T2 hyperintensity within the cervical cord at C3 and C4 levels suspected myelitis.Upper most visualized thoracic spine demonstrate extensive degenerative disc disease however without central spinal stenosis. The signal intensity of visualized thoracic cord is unremarkable.
1.Nonenhanced brain MRA demonstrate no evidence of any significant foci of vascular lumen compromise or distal occlusion.2.Nonenhanced brain MRI demonstrate focus of restricted diffusion involving the cortex of left occipital lobe without hemorrhage or any mass effect consistent with acute ischemic stroke. Minimal tiny foci of FLAIR hyperintensity in the in the subcortical and periventricular white matter of cerebral hemispheres although nonspecific considering patient's stated age of 86 likely representing chronic nonhemorrhagic microvascular ischemic changes. Mild prominence of cortical sulci and cerebellar-acromion folia likely within normal range for the stated age and unremarkable nonenhanced brain MRI otherwise.3.Nonenhanced MRI of cervical spine demonstrate extensive degenerative disc disease throughout the cervical spine with multilevel disc fusion. There are significant central spinal stenosis at C3-C4 and C4-C5 levels and to a lesser degree at other levels as detailed. There are multilevel bilateral significant neural foraminal compromise as detailed per level above. Highly suspected subtle increased T2 signal intensity of the cord at C3 and C4 suspected of myelitis.