Clinical question: rule out central lesionSigns and Symptoms: LUE weakness, increase reflexes in LLE, numbness in LUEAcute myeloid leukemia. Acute myelogenous leukemia. 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 enhancing 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 some mild mucosal thickening. The visualized portions of the mastoid air cells demonstrate scattered opacities. 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. No abnormal enhancing lesions are identified in the cervical spine. There is multilevel disc desiccation presentAt 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 is a disc bulge present at this levelAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is a disc bulge present at this levelAt C5-6 there is no significant compromise to the spinal canal. There is loss of disc space height, endplate reactive changes, diffuse disc bulge and bilateral uncovertebral osteophytes at this level associated with some narrowing of the neural foramina right worse than left with some encroachment of the right-sided exiting nerve roots within the neural foramen.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.Brachial plexus:The subclavian arteries and veins are identified and are intact. Nerve roots from the cervical spine can be followed. Within the region of the left brachial plexus no mass lesions are appreciated.There is asymmetric T2 signal hyperintensity involving the left brachial plexus and surrounding soft tissues and muscles of the scapula. There is no obvious asymmetric enhancement to the left side.
1.Periventricular and subcortical white matter changes of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There are some degenerative changes present in the cervical spine with encroachment of the nerve roots within the right neural foramen at C5-6.3.No brachial plexus mass is appreciated to explain the patient's symptoms.4.There is asymmetric signal in the tissues surrounding the left brachial plexus. I suspect this is artifactual related to inhomogenous fat suppression. There is no obvious thickening of the plexus appreciated. A subtle infiltration or early stages of plexopathy may be overlooked.