Diagnosis: Syncope and collapse Syncope and collapseClinical question: evaluate for stroke vs. Seizure nidusSigns and Symptoms: as above MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. No foci of diffusion restriction are appreciated within the brain parenchyma.There is a mild to moderate degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images. Additional T2 and FLAIR hyperintense foci are present in the brainstem.No abnormal mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The visualized portions of the paranasal sinuses demonstrate mild mucosal thickening.. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. There is multilevel disc desiccation presentAt C2-3 there is no significant compromise to the spinal canal or neural foramina. There is some disc desiccation present at this level.At C3-4 there is loss of disc space height, disc desiccation and diffuse disc bulge associated with some uncovertebral osteophytes predominantly in the left side and ligamentum flavum hypertrophy. There is associated flattening of the spinal cord and effacement of spinal fluid ventral and posterior the spinal cord. There is cord T2 signal hyperintensity within the spinal cord at this level especially the left hemicord. There is encroachment of left-sided exiting nerve roots at this level due to disc material and osteophytes Overall there is severe spinal stenosis present associated with findings suggesting cord edema.At C4-5 there is loss of disc space height, disc desiccation as well as endplate uncovertebral osteophytes. The uncovertebral osteophytes and disc material is more prevalent on the left side where there is encroachment of the left-sided exiting nerve roots. There is also effacement of spinal fluid ventral and posterior the left hemicord at this level and partial effacement of spinal fluid ventral and posterior the right hemicord. There is hypertrophy of the ligamentum flavum present. Overall there is moderate spinal stenosis at this level. There is mild flattening of the spinal cord.At C5-6 there is loss of disc space height, disc desiccation as well as endplate and uncovertebral osteophytes associated with encroachment of the exiting nerve roots within the neural foramina bilaterally. There is hypertrophy of the ligamentum flavum present. There is also effacement of the spinal fluid ventral and posterior the spinal cord at this level. Overall there is moderate spinal stenosis at this level with mild cord flatteningAt C6-7 there is loss of disc space height, endplate and uncovertebral osteophytes as well as encroachment of the exiting nerve roots within the neural foramina bilaterally. There is partial effacement of spinal fluid ventral and posterior the spinal cord. Overall there is a mild degree of spinal stenosis at this level.At C7-T1 there is no significant compromise to the spinal canal. Disc material extends into the neural foramina bilaterally at this level and is associated with some encroachment of the exiting nerve roots within the neural foramina bilaterally.The vertebral artery flow voids appear to be intact.There is enlargement of the left thyroid lobe with a heterogeneous lesion which is incompletely visualized on this exam.
1.There is severe spinal stenosis present at C3-4 associated with flattening the spinal cord and cord signal change suspicious for cord edema suspicious for spondylitic myelopathy. Please correlate with patient's clinical history for spondylitic myelopathy.2.There is a moderate degree of spinal stenosis present at C4-5 associated with mild cord flattening due to degenerative changes.3.There is a moderate degree of spinal stenosis at C5-6 associated with some mild/minimal cord flattening related to degenerative changes.4.There is encroachment of exiting nerve roots bilaterally at C5-6 and C6-7 as well as on the left-sided C3-4 and C4-5 due to degenerative changes.5.The left lobe of the thyroid gland appears enlarged and heterogeneous. This is not adequately imaged on this examination. Please correlate with patient's clinical history and symptoms.6.Periventricular and subcortical white matter lesions of a mild to moderate degree as well as some patchy lesions in the brainstem are nonspecific. At this age they are most likely vascular related. 7.There is no evidence for acute ischemic cerebral infarction.