73 years, Male, Reason: brainstem lesion to explain oculomotor palsy History: upgaze palsy, strabismus. Multiple myeloma. BRAIN
1. Chronic left PCA territory infarct involving the left occipital lobe with additional chronic lacunar infarcts involving the left thalamus and left paramedian midbrain. No evidence of acute ischemia or intracranial mass effect. 2. Multiple scattered supra- and infratentorial chronic microhemorrhages.3. No discrete myelomatous lesions are evident in the cervical, thoracic, or lumbar spine within the limits of noncontrast imaging.4. Multilevel degenerative changes with no significant spinal canal stenosis in the cervical or thoracic spine. In the lumbar spine there is moderate L3-L4 spinal canal stenosis and to a milder degree at the L4-L5 and L2-L3 levels. Additional details including foraminal stenoses as described above.