Recent gait instability/imbalance (since July 2015) and paresthesias in bilateral hands for approximately 1 year. Differential includes: paraneoplastic syndrome, prion disease, ALS, multisystem atrophy, vasculitis, hep C peripheral neuropathy and CNS disease. . Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There is a subcentimeter focus of T2 hyperintensity in the left middle frontal gyrus, which is nonspecific. There is no abnormal intracranial enhancement. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There are secretions in the left posterior ethmoid sinus.Cervical Spine: There is multilevel degenerative spondylosis of the cervical spine superimposed upon a congenitally narrow spinal canal and thickening of the posterior longitudinal ligament. In particular, there is compression of the spinal cord at C3-4, C4-5, and C6-7 and neural foraminal stenoses bilaterally. In addition, there is volume loss and high signal within the spinal cord at these levels. There is minimal anterolisthesis of C4 on C5 and minimal retrolisthesis of C3 on C4. The vertebral bone marrow displays degenerative endplate signal alterations at multiple levels, but is otherwise unremarkable. The vertebral body heights are preserved. No mass lesions are present in the cervical spine. The paravertebral soft tissues are unremarkable.
1. No evidence of acute intracranial hemorrhage, mass, or acute infarct.2 .Multilevel degenerative spondylosis of the cervical spine superimposed upon a congenitally narrow spinal canal and thickening of the posterior longitudinal ligament.