Clinical question: Walking trouble, right leg weakness per history. Signs and symptoms: Spastic in legs and significant sensation loss. Nonenhanced brain MRI:Negative diffusion weighted series.Examination demonstrates diffuse patchy foci of flair and T2 hyperintensity primarily in the periventricular and to a lesser degree subcortical as well as bilateral basal ganglia, left thalamus and pons without associated susceptibility signal changes. Considering patient's stated age of 76 findings are highly suggestive of chronic nonhemorrhagic small vessel ischemic strokes of mild degree.The slight prominence of ventricular system as well as the cortical sulci although may be at the upper limits of normal possibly show mild underlying parenchymal volume loss is suspected.The signal voids of major intracranial arterial branches are identified.The signal intensity of intracranial venous sinuses are within normal.Unremarkable images through the orbits, paranasal sinuses, mastoid air cells as well as calvarium and soft tissues of the scalp.Nonenhanced cervical MRI:There is generalized smaller size of the spinal canal which is suspected to represent a congenital anatomical variation.There is mild to moderate degenerative changes of cervical spine however with normal alignment. Mild straightening of cervical lordosis is noted.Foramen Magnum demonstrate mild hypertrophy changes of posterior elements and ligamentous hypertrophy and including the posterior longitudinal ligament. Findings results in mild spinal stenosis at this level.C2 -- C3 demonstrate mild degenerative changes, mild central spinal stenosis and no neural foraminal compromise.C3 -- C4 demonstrate moderate loss of disk height, shallow centrally located osteophyte which results in slight flattening and deformity of the ventral aspect of the cord. There is mild central spinal stenosis and moderate right neural foraminal compromise.C4 -- C5 demonstrate mild disk disease with loss of disk height, broad-based central disk protrusion which in combination with moderate ligamentum flavum hypertrophy and congenitally small canal results in significant flattening deformity of the cord and central spinal stenosis. There is significant right and moderate left neural foraminal compromise at this level also. On sagittal T2 series there is suggestion of very subtle increased T2 signal intensity of the cord which could represent edema or myelomalacia.C5 -- C6 demonstrate minimal degenerative changes of the disk and facets as well as ligamentum flavum which in combination with congenitally narrow canal results in mild to moderate central spinal stenosis and moderate left and mild right neural foraminal compromise.C6 -- C7 demonstrate mild disk disease with loss of disk height shallow broad based bulge of disk and mild hypertrophic changes of posterior elements. There is resultant mild central spinal stenosis and mild bilateral neural foraminal compromise.C7 -- T1 is unremarkable.Uppermost visualized thoracic spine through T3 are unremarkable.
1.Nonenhanced head brain MRI demonstrates no acute intracranial process. Findings suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes as detailed. Unremarkable calvarium, orbits, paranasal sinuses and mastoid air cells.2.Non-enhanced MRI of the cervical spine demonstrate generalized uniform smaller than expected caliber of the spinal canal suggestive of a congenital anatomical variation. Degenerative changes of cervical spine in combination with congenitally small canal results in multilevel central spinal stenosis and multilevel bilateral neural foraminal compromise (some significantly) as detailed per level. Spinal stenosis is most severe at C4 -- C5 and with resultant significant flattening deformity of the cord. There is suspected T2 hyperintensity of the cord at this level which could represent an cord edema on or myelomalacia. Please see detailed report above.