Clinical question: Rule out mass lesion. Signs and Symptoms: Dystonia and myoclonus. Nonenhanced brain MRI:Negative diffusion weighted series.There is normal anatomical development of brain and with normal signal intensity on all MRI sequences.There is mild prominence of the cerebral cortical sulci and the cerebellar and the vermian folia for patient's stated age of 52 years. Unremarkable cerebral cortex, ventricles, CSF spaces and the brain myelination.Unremarkable calvarium, scalp, orbits, paranasal sinus and mastoid air cells.\Nonenhanced cervical MRI:The alignment of the vertebral column is within normal however there is significant reversal of cervical lordosis secondary to extensive degenerative changes at C5-C6, C6-C7 and to a lesser degree at C4-C5 levels.Foramen magnum is unremarkable.C2-C3 demonstrate minimal degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild degenerative changes and unremarkable otherwise.C4-C5 demonstrates a large central and left paramedian broad-based disc protrusion with resultant significant mass effect, flattening deformity and posterior displacement of the cord resulting in moderate to significant central spinal stenosis and no neural foraminal compromise. There is questionable subtle T2 STIR hyperintensity of the cord.C5-C6 demonstrate moderate disc disease and loss of disc height and mild bilateral (L>R) facet and uncovertebral hypertrophic changes. Constellation of changes results in moderate to severe central spinal stenosis and mild right and significant left neural foraminal compromise.C6-C7 demonstrate advanced disc disease and loss of disc height, moderate bilateral facet and mild ligamentum hypertrophy. There is mass effect, flattening and posterior displacement of the cord and severe central spinal stenosis, severe left and moderate right neural foraminal stenosis. Small focus of T2 stir hyperintensity of the cord at this level concerning for myelopathy.C7-T1 demonstrate mild degenerative disease without spinal canal or neural foraminal stenosis.
1.Unremarkable nonenhanced brain MRI as detailed. Please see above comments.2.Cervical spin MRI demonstrate extensive degenerative changes at C4-C5 through C6-C7 with resultant reversal of cervical lordosis and moderate to severe central spinal stenosis and neural foraminal stenosis. There is a central and leftward disc protrusion at C4-C5 level which significantly contributing to central spinal stenosis which is worst at this level. Small focus of cord T2 stir hyperintensity at C6-C7 and questionable focus at C4-C5 levels concerning for myelopathy. Please review detailed report above.