Lower extremity hyperreflexia, bilateral upper limb tingling. Gait impairment. Left lower extremity weakness. Brain: There are a few scattered foci of T2/FLAIR hyperintensity in the subcortical and periventricular white matter, which are nonspecific. Brain appears otherwise unremarkable. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Major flow-voids are preserved. Sella and orbits are grossly within normal limits. Paranasal sinuses and mastoid cells are clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical spine: There are postsurgical changes related to anterior cervical fusion at the C5-C6 and C6-C7 levels with residual C5-C6 hardware better assessed on recent CT from June 20, 2015. Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. Bone marrow signal is benign. No abnormal cord signal is appreciated.Degenerative changes are seen in the cervical spine as described below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is a disc osteophyte complex eccentric to the right with a right paracentral disc protrusion which results in effacement of the ventral thecal sac and mild impression on the right ventral aspect of the cord. Finding is progressed since prior MRI cervical spine from 7/7/2012. There is mild to moderate right neural foraminal stenosis. No significant left neural foraminal narrowing.C4-5: Small disc osteophyte complex and uncinate hypertrophy on the left with moderate left neural foraminal stenosis. Minimal right neural foraminal narrowing. Mild spinal canal stenosis.C5-6: Disc osteophyte complex and uncovertebral hypertrophy with moderate right and mild left neural foraminal stenosis. Mild spinal canal stenosis.C6-7: There is bilateral uncovertebral hypertrophy with moderate to severe left and moderate right neural foraminal stenosis. No significant spinal canal stenosis.C7-T1: No significant compromise to the spinal canal. There is facet arthropathy, particularly on the left with with mild left neural foraminal narrowing. No significant right neural foraminal narrowing.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. Brain MRI is within normal limits for age. Specifically no evidence of infarct, hemorrhage, mass or mass effect. 2. Multilevel degenerative changes in the cervical spine with evidence of prior anterior cervical fusion at C5-C6 and C6-C7 with residual C5-C6 hardware better seen on recent CT. There is up to moderate stenosis involving the right aspect of the spinal canal at the C3-C4 level related to disc protrusion which has progressed since prior MRI from 2012. There is mild spinal canal stenosis at the C4-C5 and C5-C6 levels. There is also foraminal stenosis at multiple levels as detailed above. No cord signal abnormality.