Female, 70 years old, with new arm numbness and weakness and worsening leg weakness. History of multiple myeloma. Brain:A moderately sized chronic infarct of the right middle frontal gyrus is unchanged. Numerous small cortical infarcts are evident elsewhere within the right cerebral hemisphere and in the bilateral cerebellum. No evidence of restricted diffusion is seen to suggest acute ischemia.Extensive patchy periventricular and subcortical T2 hyperintensity is seen, a nonspecific finding which is nevertheless unchanged. No evidence of parenchymal edema or mass-effect seen. No significant intracranial hemorrhage is detected. The ventricular system is normal in size and morphology. A developmental venous anomaly is evident within the left corona radiata. No pathologic parenchymal or extra-axial enhancement is seen.Cervical spine:Image quality is degraded by motion artifact. Within this limitation, the following observations are made.Bone marrow signal characteristics are mildly but diffusely heterogeneous. In addition, the C3 vertebral body is uniformly T2 hyperintense and mildly enhancing. Similar findings are seen within the right aspect of the T1 vertebral body and both pedicles. A few foci of abnormal T2 hyperintense signal is also seen within the C7 vertebral body and right pedicle, and the left T2 pedicle and facet complex. Ill-defined abnormal signal and enhancement is also seen along the proximal left T2 and T3 ribs.Spinal alignment is anatomic. Vertebral body heights and morphology are normal.No evidence of pathologic intradural or spinal cord enhancement is seen.C2-3: Mild facet hypertrophy. Otherwise unremarkable.C3-4: Mild facet hypertrophy. Mild posterior disk osteophyte formation. Mild spinal canal stenosis without cord impingement. No significant foraminal narrowing.C4-5: Mild facet hypertrophy. Posterior disk osteophyte formation with a right paracentral protrusion. Mild to moderate spinal canal stenosis with slight deformation of the ventral cord but no cord signal abnormality. Mild left and moderate right foraminal narrowing. C5-6: Mild facet hypertrophy. Posterior disk osteophyte formation. Mild spinal canal stenosis with slight deformation of the ventral cord but no abnormal cord signal. Mild left foraminal narrowing. C6-7: Facet hypertrophy. Posterior disk osteophyte formation. Mild spinal canal stenosis with very slight flattening of the ventral cord but no cord signal abnormality. No significant foraminal narrowing. C7-T1: Mild facet hypertrophy. Posterior disk osteophyte formation with a left paracentral protrusion. No significant spinal canal stenosis or cord impingement. No significant foraminal narrowing.
1.Evidence of extensive chronic cortical and small vessel ischemic disease. No evidence of any acute intracranial abnormality.2.Scattered areas of pathologic marrow signal intensity and enhancement are seen within the cervical region. These may reflect the patient's stated history of multiple myeloma. These lesions do not result in any significant epidural encroachment, spinal canal or neuroforaminal stenosis.3.Multilevel cervical spondylosis is seen with mild to moderate spinal canal stenosis and mild cord impingement as discussed above.