Diagnosis: Other malaise and fatigue. Other malaise and fatigueClinical question: Is there stenosis?Signs and Symptoms: back pain and weakness MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.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 are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact.Exam is mildly degraded due to patient motionMRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. At C2-3 there is no significant compromise to the spinal canal or neural foramina.At C3-4 there is no significant compromise to the spinal canal or neural foramina. There are bilateral uncovertebral osteophytes present this level which are more on the left versus the right side where there is encroachment of the nerve roots of the left-sided exiting nerve root and encroachment on the left hemicord. This has progressed since the 2009 examAt C4-5 there are endplate and uncovertebral osteophytes present associated with some mild narrowing of the neural foramina bilaterally more on the left versus the right side. There is encroachment of the exiting nerve roots within the left neural foramen at this this was also present on the prior exam from 2009. It has not changed substantially since.At C5-6 there are endplate and uncovertebral osteophytes present with encroachment of the neural foramina bilaterally but more on the right and the left side where there is encroachment of the right-sided exiting nerve roots. This was also present on the prior exam and has not changed substantially.At C6-7 there are endplate and uncovertebral osteophytes present associated with disc material and mild narrowing of the neural foramina bilaterally. This was also present on the 2009 exam and not substantially changed.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.
1.There are multilevel degenerative changes present in the cervical spine with multilevel encroachment of exiting nerve roots on the left side at C3-4, and the left side at C4-5 and the right-sided C5-6. These are largely stable since the prior exam except that the encroachment of the left exiting nerve roots at C3-4 has progressed2.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 3.Examination is mildly degraded due to patient motion which may obscure more subtle abnormalities.