Diagnosis: Other idiopathic scoliosis, site unspecified Other symptoms and signs involving the musculoskeletal systemClinical question: loss of motor function to right lower extremity when positioned prone for spinal procedure, eval for vascular or other abnormalitySigns and Symptoms: loss of motor function to right lower extremity MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. 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 only minor opacities.. 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. 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.At C4-5 there is no significant compromise to the spinal canal or neural foramina.At C5-6 there is no significant compromise to the spinal canal or neural foramina.At C6-7 there is no significant compromise to the spinal canal or neural foramina.At C7-T1 there is no significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height.There is a 4 mm lesion present in the right hemicord at the T8-9 disc space level. It is high signal on T2. There is some suggestion of diffusion restriction.The patient is status post lower thoracic and upper lumbar spine surgery. Pedicle screw tracts are present at L2, L1, T12 and T11. There are postoperative changes identified in the tissues superficial to the lower thoracic and upper lumbar spine.There is a small right pleural effusion present.Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. There is a compensatory levocurvature to the lumbar spine. The conus medullaris on sagittal imaging is grossly intact.Pedicle screw tracts are present at L2, L1, T12 and T11. There are postoperative changes identified in the tissues superficial to the lower thoracic and upper lumbar spine.At L5-S1 there is no significant compromise to spinal canal or neural foramina.At L4-5 there is no significant compromise to spinal canal or neural foramina.At L3-4 there is no significant compromise to spinal canal or neural foramina.At L2-3 there is no significant compromise to spinal canal or neural foramina.At L1-2 there is no significant compromise to spinal canal or neural foramina.The bladder is relatively full. There appears to be a small air bubble in the urinary bladder.
1.There is a 4 mm lesion present in the right hemicord at the T8-9 disc space level involving gray matter. It is possible that this relates to a small spinal cord infarction based on some questionable evidence for diffusion restriction. The lesion may have been present on the prior exam but not visible on the prior exam due to low signal to noise on that exam.2.There is a small right pleural effusion present.3.There is no compromise to the cervical spinal cord or lumbar spinal cord appreciated.4.Findings were discussed with Dr Sullivan at around 9 am on 11/24/15.5.Scoliosis6.Status post lower thoracic and upper lumbar spine surgery. Pedicle screw tracts are identified in the bilateral pedicles of T11, T12, L1 and L2.7.The bladder is relatively full. This is a nonspecific finding. There appears to be a small air bubble in the urinary bladder.