Male, 70 years old, with elevated protein in CSF, nuchal rigidity, status post OHT. Cervical:Within the limitations of a motion degraded exam, the following observations are made. Alignment is anatomic. Vertebral body height and morphology are within normal limits. No pathologic marrow replacement or edema is seen. The visualized spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are suspected. Minimal disc osteophyte formation is seen without high-grade spinal canal stenosis. At most minimal scattered foraminal narrowing is demonstrated.Thoracic:Within the limitations of a motion degraded exam, the following observations are made. A mild scoliotic curvature is seen. Sagittal alignment is within normal limits. Mild anterior wedging of the T6 vertebral body is seen without marrow edema. The remaining vertebral bodies demonstrate preservation of height. No pathologic marrow replacement or edema is detected. The spinal cord shows normal signal intensity and morphology throughout. No epidural abnormalities are seen. Mild scattered disc degeneration is seen without significant spinal canal or foraminal compromise. Small pleural effusions are seen bilaterally.Lumbar:Within the limitations of a motion degraded exam, the following observations are made. Grade 1 retrolisthesis of L2 relative to L3 and L3 relative to L4 is seen. Vertebral body heights are preserved. Marrow signal characteristics are somewhat heterogeneous with scattered Schmorl's node deformities. However, no pathologic marrow replacement or edema is detected.A fluid-fluid level is evident dependently within the sacral thecal sac. In addition, the distal cauda equina nerve roots are clumped and disorganized with intermixed T1 hyperintense strands. The distal spinal cord and conus are unremarkable. No epidural abnormalities are suspected.L1-2: Loss of disc T2 signal but no significant compromise of the spinal canal or neural foramina. L2-3: Loss of disc T2 signal and disc bulging with a left far lateral annular fissure. No significant compromise of the spinal canal. Mild narrowing of the neural foramina. L3-4: Loss of disc T2 signal. Mild disc bulging. Mild compromise of the spinal canal and neural foramina. L4-5: Mild facet arthropathy. Minimal disc bulging. No significant spinal canal stenosis. Mild compromise of the neural foramina. L5-S1: Moderate facet arthropathy. Mild disc bulging. No significant compromise spinal canal. Mild narrowing of the left neural foramen.
1.A fluid-fluid level is evident layering dependently within the sacral thecal sac along with clumping and disorganization of the nerve roots and intermixed T1 hyperintense strands. This is favored to represent blood degradation product with scattered blood clots. The possibility of infection is not excluded, and infection may certainly coexist with hemorrhage. However, meningitis on its own typically does not produce this amount of gross intrathecal debris.2.Very mild disc degeneration is seen in the cervical and thoracic spine with moderate degenerative findings in the lumbar spine. No areas of high-grade spinal canal stenosis are detected.