 Brain: No diffusion weighted abnormalities. Stable focus of encephalomalacia in the high convexity right posterior frontoparietal region at the site of prior craniotomy without evidence of interval change. Extensive periventricular and subcortical T2 hyperintensity of the bilateral cerebral hemispheres, which appears without symmetric and change from prior study. Extensive similar foci of flair hyperintensity are also noted in bilateral paramedian pons without change. Marrow signal changes of clivus and increased tissue fullness within the dorsal aspect of the sphenoid sinus which with mild enhancement, stable from 06/2013 study. No evidence of mass, mass effect, or hydrocephalus. No extra-axial fluid collections. Flow voids are present within the major vessels indicating patency. Unchanged patchy opacification of bilateral ethmoid air cells, left greater than right.Cervical spine: There is loss of the cervical lordosis. There is multilevel degenerative endplate degenerative marrow signal changes. There is mild multilevel spinal canal stenosis associated with disc-osteophyte complexes. There is no abnormal spinal cord signal or enhancement. There is no evidence of mass lesions. The paraspinal soft tissues are unremarkable. C1/2: No evidence of foraminal narrowing or spinal canal stenosis.C2/3: Mild disk disease. No evidence of foraminal narrowing or spinal canal stenosis.C3/4: Moderate disk disease. Severe left and mild right neural foraminal narrowing. Mild central canal stenosis. C4/5: Advanced disk disease with loss of disk height. Minimal retrolisthesis of L4 over L5 vertebral body. There is shallow ventral epidural defects, likely spur, with progression of Modic endplate changes. Mild ligamentum and facet hypertrophy. Significant bilateral neural foraminal narrowing, right greater than left. There is progression of moderate central canal stenosis. C5/6: Advanced disk disease with loss of disk height. Significant right and mild left neuroforamina stenosis. Mild central canal stenosis. C6/7: Mild disk disease. No evidence of foraminal narrowing or spinal stenosis. C7/T1: Mild disk disease. No evidence of foraminal narrowing or spinal stenosis.
1.Periventricular and subcortical white matter T2 hyperintensity, stable from prior study.2.Stable marrow signal change, increased tissue density, and mild enhancement of the clivus. This finding is stable from 06/2013 study, but recommend CT without contrast with thin section through the skull base for further evaluation.3.Multilevel degenerative disk disease of the cervical spine with progression of disease at C4/5 level with moderate central canal stenosis.