65 years, Male, intermittent left-sided weakness, history of well-controlled HIV, concussions from prior sports. Brain: Again seen are multiple foci of T2/FLAIR hyperintensity in the bilateral periventricular and subcortical white matter, notably punctate foci in the left frontal corona radiata, adjacent to the bilateral temporal horns, and a relatively larger focus surrounding the atrium of the right lateral ventricle which measures approximately 10 x 20 mm in the coronal plane. Compared to 6/26/2009 there is no appreciable change. No intracranial mass or mass effect. No abnormal enhancement. No evidence of acute ischemia or hemorrhage. Major flow-voids are preserved. Brain parenchymal volume is preserved. Paranasal sinuses and mastoid air cells are clear. Calvarium and extracranial soft tissues are unremarkable. Cervical spine: Craniocervical junction is within normal limits. Vertebral body heights are normal. Alignment of the cervical spine is maintained. Bone marrow signal is benign. T1 hyperintense lesion involving the right aspect of the C6 vertebral body is consistent with a small hemangioma. The cervical cord is normal in signal characteristics and contour. There is no significant spinal canal stenosis at any level. No abnormal enhancement is appreciated. There are mild multilevel degenerative changes including disc desiccation throughout. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: There is no significant spinal canal stenosis. There is uncovertebral hypertrophy bilaterally resulting in mild left worse in right neural foraminal stenosis, and slightly worse then on prior from 2011C4-5: No significant compromise to the spinal canal or neural foramina.C5-6: No significant compromise to the spinal canal or neural foramina.C6-7: No significant spinal canal or right neural foraminal narrowing. There is mild left-sided neural foraminal stenosis related to uncovertebral hypertrophy minimally worse than prior.C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. Compared to MRI brain dated 6/26/2009, there is no significant change in multiple foci of T2/FLAIR signal abnormality involving the periventricular and subcortical white matter including a relatively larger area in the right periatrial white matter. Findings most likely represent sequela of prior demyelination, infection, or other remote injury. 2. No abnormal signal in the cervical cord or abnormal enhancement. Mild degenerative changes are seen in the cervical spine which are stable to minimally worse since prior study from 2011. There is up to mild left greater than right C3-C4 neural foraminal stenosis and mild left C6-C7 neural foraminal stenosis. No high-grade neural foraminal or spinal canal stenosis at any level.