Bilateral trigeminal and hypoglossal nerves sensory complaints. Evaluate for brainstem pathology. Image quality is degraded by motion artifact.Brain: There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered punctate foci and confluent areas of abnormal T2/FLAIR hyperintensity within the periventricular and subcortical white matter, consistent with mild chronic small vessel ischemic changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. No mass or abnormal enhancement is seen involving the cisternal segment of the trigeminal nerves, Meckel's cave, or cavernous sinus. The skull and extracranial soft tissues are unremarkable. No obvious mass involving the skull base is appreciated.Cervical spine: Examination is somewhat technically degraded. The vertebral body heights are preserved. There is minimal C3 on C4 and C4 on C5 retrolisthesis as well as mild C7 on T1 anterolisthesis similar to prior. There is moderate disc space narrowing throughout the cervical spine. There is fusion of the C5-C6 vertebral bodies. The vertebral bone marrow signal is unremarkable. The paravertebral soft tissues are unremarkable.Ill-defined T2 hyperintensity in the cervical cord on the sagittal sequences is favored to be artifactual and not seen on the axial T2 sequence. No convincing cord signal abnormality is appreciated. No abnormal enhancement.C2-C3: Unchanged posterior disc osteophyte complex and bilateral facet degeneration. No significant spinal canal or right foraminal stenosis. Mild left neural foraminal narrowing.C3-C4: Posterior disc osteophyte complex, bilateral uncinate spurs and bilateral facet degeneration, contributing to mild bilateral foraminal narrowing. Mild spinal canal narrowing.C4-C5: Posterior disc-osteophyte complex, thickening of the ligamentum flavum, bilateral uncinate spurs and bilateral facet degeneration, contributing to moderate spinal canal stenosis particularly at the right lateral aspect of the spinal canal. There is moderate to severe right and mild left neural foraminal narrowing.C5-C6: There is fusion of C5 and C6 vertebral levels. There is mild right foraminal stenosis. No significant spinal canal or left neural foraminal narrowing.C6-C7: Posterior disc-osteophyte complex, bilateral uncinate spurs and facet degeneration, contributing to mild left greater than right foraminal stenosis and mild spinal canal narrowing. C7-T1: Disc bulge, ligamentum flavum thickening and bilateral facet degeneration, contributing to mild bilateral neural foraminal narrowing.
1. No intracranial mass or mass effect. Specifically, no lesion within the brainstem is appreciated. Dedicated cranial nerve high-resolution sequences were not obtained however no obvious mass or abnormal enhancement is seen involving the visualized course of the trigeminal nerves or at the hypoglossal canals. There is evidence of mild chronic small vessel ischemic disease.2. No significant interval change in multilevel degenerative changes of the cervical spine. There is up to moderate spinal canal stenosis at the C4-C5 level and to a mild degree at C3-C4 and C6-C7. There is moderate to severe right C4-C5 neural foraminal stenosis. Ill-defined T2 signal on the sagittal T2/STIR sequences in the cervical cord is not corroborated on the axial sequence and likely artifactual. No definite cord signal abnormality or enhancement.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.