Clinical question: New ischemia. Signs and symptoms: 78-year-old female with right arm weakness and numbness. Nonenhanced brain MRI:No acute intracranial process and negative diffusion weighted series.Examination demonstrate several tiny bilateral cerebellar chronic nonhemorrhagic ischemic strokes in this distribution of bilateral PICA branches as well as bilateral superior cerebellar arteries. Unremarkable pons and medulla. There is no significant change in the extent of this finding since prior exam from October 2014.Images through the supratentorial space demonstrate extensive varying size patchy foci of FLAIR and T2 hyperintensity in bilateral cerebral hemispheres and bilateral basal ganglia consistent with chronic nonhemorrhagic small vessel ischemic strokes. Additionally a small focus of chronic minimally hemorrhagic cortical stroke in the right anterior frontal lobe is present. There is also no significant interval change in the extent of supratentorial chronic ischemic strokes since prior study. Mild prominence of bilateral cerebral cortical sulci and mildly prominent supratentorial ventricular system remain similar to prior exam.The signal void of major intracranial arterial branches are present and identified. Images through the orbits are unremarkable and all paranasal sinuses and bilateral mastoid air cells demonstrate normal pneumatization signal patterns. Unremarkable calvarium and soft tissues of the scalp.Nonenhanced cervical MRI:Foramen magnum is unremarkable.C2-C3 demonstrate minimal degenerative changes with resultant mild right neural foraminal compromise.C3-C4 demonstrate mild left-sided uncovertebral hypertrophy with resultant mild left neural foraminal compromise and unremarkable otherwise.C4-C5 demonstrate moderate disc disease and loss of disc height, moderate asymmetric left facet hypertrophy and mild ligamentum flavum and right facet degenerative changes. Constellation of findings result in moderate right and severe left neural foraminal compromise and mild central spinal stenosis.C5-C6 demonstrate advanced disc disease and loss of disc height, moderate asymmetric left facet hypertrophy, mild bilateral ligamentum flavum and right facet degenerative/hypertrophic changes. Constellation of findings results in mild central spinal stenosis, significant right and moderate left neural foraminal compromise.C6-C7 demonstrate advanced disc disease and loss of disc height, larger ventral (right greater than left) disc osteophyte complex and mild bilateral facet and ligamentum flavum hypertrophy is noted. Constellation of findings results in mild central spinal stenosis and significant bilateral (right > left) neural foraminal compromise.C7-T1 demonstrate mild degenerative disc disease and moderate bilateral (right greater than left) facet and ligamentum flavum hypertrophy. There is resultant significant bilateral neural foraminal compromiseThe alignment of vertebral condyle remains anatomic. The signal intensity and caliber of cervical and upper most visualized thoracic cord is unremarkable.
1.Nonenhanced brain MRI demonstrate no acute intracranial process and no restricted diffusion. Extensive chronic bilateral cerebellar strokes as well as supratentorial chronic small vessel ischemic strokes and a right frontal cortical stroke remains nearly identical to prior study from October of 2014.2.Examination of cervical spine demonstrate extensive degenerative changes primarily at C4-C5 through C6-C7 levels with resultant mild central spinal stenosis at all of these levels. Additionally there are multilevel bilateral neural foraminal compromise (some significantly) as detailed per level above. Normal signal intensity and caliber of cervical and upper most visualized thoracic cord.