 Brain MRI:There are scattered foci of T2 hyperintensity within subcortical white matter without associated mass effect, restricted diffusion, or susceptibility abnormality. There is no similar appearing foci within the posterior fossa. The ventricles and sulci are normal in size. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. The pituitary gland is normal in size. There is no evidence for intracranial hemorrhage or acute cerebral, brainstem or cerebellar infarction. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Note is made of falcine calcifications.Cervical spine MRI:Alignment is anatomic. There are no fractures or subluxations. The marrow signal is benign. The cervical and upper thoracic cord are normal in signal. The cervicomedullary junction is normal. The cerebellar tonsils are in normal position. The visualized paraspinal contents are unremarkable.C2/3: Right facet hypertrophy encroaches the right neural foramen however without significant resulting stenosis.C3/4: Posterior osteophyte disc complex, bilateral uncinate hypertrophy, and mild bilateral facet hypertrophy. There are no significant stenoses.C4/5: Posterior osteophyte disc complex causes anterior cord flattening without intrinsic cord signal abnormality. There is also bilateral uncinate hypertrophy and mild bilateral facet hypertrophy. There is no significant central stenosis, however there is mild bilateral neural foraminal stenosis.C5/6: UnremarkableC6/7: Mild bilateral uncinate hypertrophy and slight ligamentum flavum thickening. There are no significant stenoses.C7/T1: There is lateral left facet hypertrophy and mild right facet hypertrophy. There is mild left neural foraminal stenosis.
1.There are scattered nonspecific foci of T2 hyperintensity within subcortical white matter without associated mass effect, restricted diffusion, or susceptibility abnormality. This MR appearance is most suggestive of small vessel ischemic disease and the differential diagnosis would most likely include migraine sequelae. Given the lack of susceptibility abnormality, residua from previous head trauma is felt to be less likely. Given lesional morphology and location, a myelination is felt to be unlikely.2.C4/5: Posterior osteophyte disc complex causes anterior cord flattening without intrinsic cord signal abnormality. There is also mild bilateral neural foraminal stenosis.3.C7/T1: Mild left neural foraminal stenosis.