Clinical question: 62 year-old female with neck pain, limited head mobility, paresthesia down to arm. Signs and symptoms: Paresthesia, arm weakness, pain. Nonenhanced brain MRI:Negative diffusion weighted images.Examination demonstrates an enlarged pituitary gland which results in expansion of sella. Finding is consistent with a pituitary macroadenoma measuring 14.5-mm in height. There is no extension into the basal cistern or the cavernous sinuses on this nonenhanced non-dedicated study.The anatomical morphology and the signal intensity of brain parenchyma otherwise remains within normal on all MRI sequences.Unremarkable cerebral cortex, cortical sulci, ventricular system, CSF spaces and mild herniation of brain.Signal void the major intracranial arterial branches is identified.The signal intensity of intracranial venous sinuses remain within normal. Unremarkable images through the orbits, paranasal sinuses and mastoid air cells.Nonenhanced cervical MRI: There is normal anatomical alignment of the vertebral column however with mild reversal of the cervical lordosis.There is mild-to-moderate disk disease throughout the cervical spine and uniform hypertrophy of the posterior longitudinal ligament extending from C2 to T1 level. This finding results in near complete effacement of ventral subarachnoid space from C3 -- C4 disk to C5 -- C6 disk level.Foramen magnum is unremarkable.C2 -- C3 is unremarkable.C3 -- C4 demonstrate moderate disk disease and loss of disk height, show no broad-based bulging disk and with resultant moderate central spinal stenosis, significant left and mild right neural foraminal compromise.C4 -- C5 demonstrate mild to moderate disk desiccation and loss of height, no significant degenerative/hypertrophic changes posterior elements. A tiny central and right paramedian disk protrusion is present. Constellation of degenerative changes at this level results in moderate right neural foramina compromise, mild to moderate central spinal stenosis and patent left neural foramina.C5 -- C6 demonstrate advanced degenerative disk and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of changes results in mild to moderate central frontal stenosis, significant right and moderate left neural foraminal compromise.C6 -- C7 demonstrate moderate disk disease and loss of disk height, mild bilateral facet and ligamentum flavum hypertrophy. Constellation of findings results in mild to moderate central spinal stenosis, significant left and moderate right neural foraminal compromise.C7 -- T1 demonstrate minimal degenerative disk disease and mild (left greater than right) ligamentum flavum hypertrophy. No central spinal stenosis or neural foraminal compromise.The signal intensity of the cord remains within normal.Uppermost visualized thoracic spine and cord to T4 level is unremarkable.No detectable perispinal soft tissue abnormalities.
1.Nonenhanced brain MRI demonstrate a pituitary macroadenoma measuring 14.5 mm in height and entirely within the sella. Unremarkable exam otherwise.2.Nonenhanced MRI of cervical spine demonstrate mild to moderate disk disease, significant posterior longitudinal ligament hypertrophy and minimal hypertrophic changes of posterior elements and mild reversal of cervical lordosis. Findings results in multilevel central spinal stenosis of mild to moderate degree extending from C 3 -- C4 through C6 -- C7 levels. There are also multilevel neural foraminal compromise (some significantly) as detailed per level. Normal signal intensity of cervical and uppermost visualized thoracic cord