Reason: RUE/RLE numbness History: RUE/RLE weakness, eval for CVA. Brain: There is no restricted diffusion to suggest acute infarct. Again noted are changes compatible with prior suboccipital craniectomy and resection of posterior arch of C1 for posterior fossa decompression, with low-lying cerebellar tonsils which extend to the inferior margin of the anterior arch of C1 not significantly changed since the prior study. The ventricles are normal in size without hydrocephalus. There is prominent volume loss involving the superior cerebellar vermis similar to prior. There is no mass, mass effect, or midline shift. Few scattered foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter as well as the pons, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Tiny lipoma along the falx incidentally noticed. Flow voids are present within the major vessels indicating patency. The paranasal sinuses and mastoid air cells are clear. Postcontrast images demonstrate no abnormal parenchymal or meningeal enhancement. Cervical spine: Again seen is T2 signal abnormality involving the right central and dorsal cervical cord from C2 to the C7 level. There is also a associated prominence of the central canal which extends to the lower T1 level on the axial T2 sequence. Overall appearance of the signal abnormality is unchanged. No abnormal enhancement in the cervical spine.Cervical spine alignment is unchanged with reversal of cervical lordosis and mild retrolisthesis of C4 on C5. Bone marrow signal is benign. The vertebral body heights are preserved. No abnormal enhancement. Degenerative changes are specified by the intervertebral level as follows: C2-C3: Minimal disc osteophyte complex without spinal canal stenosis or neural foraminal compromise is identified. C3-C4: Small disk osteophyte complex with mild narrowing of the spinal canal and effacement of the ventral thecal sac. No significant neural foraminal stenosis.C4-C5: Small disk osteophyte complex with effacement of the ventral thecal sac. Minimal right foraminal narrowing, otherwise no significant neural foramina stenosis. C5-C6: Disk-osteophyte complex without significant spinal canal or neural foramina stenosis.C6-C7: Small disk osteophyte complex without significant spinal canal or neural foramina stenosis.C7-T1: No spinal canal stenosis or neural foraminal compromise.
1.No evidence of acute infarct. No intracranial mass or mass effect. Postsurgical changes of prior Chiari I decompression without significant interval change in position of the low-lying cerebellar tonsils. 2.No significant change in extensive right cervical cord myelomalacia with small adjacent syrinx.3.Mild multilevel degenerative changes as detailed above with mild spinal canal stenosis at C3-C4 and C4-C5. No high-grade spinal canal or neural foraminal stenosis at any level.