Reason: 61 y/o man w/ ptosis of the left eyelid for the past 2 mo and weight loss. MRI Brain:There are innumerable scattered subcortical and periventricular white matter T2/FLAIR hyperintense foci, indicating chronic small vessel ischemic disease. The cerebral sulci and ventricles are prominent bilaterally, indicating mild global volume loss. The cerebellar tonsils are in normal position. There are no masses, mass effect or midline shift. No diffusion-weighted abnormalities are identified. There are no extraaxial fluid collections or subdural hematomas. Flow voids are present within the major vessels indicating patency. There are two retention cysts within the right maxillary sinus. There is no abnormal enhancement within the brain. MRI Orbit:This exam is partially limited by motion artifact. The globes are intact. No intraconal or extraconal space mass is identified. The extraocular muscles are intact. The lacrimal glands are symmetric and within normal limits in size and configuration. There is no optic nerve enhancement appreciated. The suprasellar cistern is intact. There is a subtle lobulated irregularity of the left posterior globe, likely representing staphyloma. The right globe is elongated in the AP dimension, which likely relates to myopia.MRI Cervical Spine:There is heterogeneous marrow signal, which is nonspecific. There is multilevel narrowing of intervertebral discs. There is C3 on C4 retrolisthesis by 4 mm. There is C4 on C5 anterolisthesis by 4 mm. There is trace anterolisthesis of C7 on T1 and of T1 on T2. Cervical spinal cord signal intensity and morphology are normal throughout. C2-3: There is no evidence of significant neural foraminal or central canal stenosis.C3-4: There is disc osteophyte complex and uncovering of the intervertebral disc, resulting in moderate central canal stenosis, moderate to severe left foraminal stenosis, and moderate right foraminal stenosis. There is uncovertebral joint hypertrophy at this level.C4-5: There is disc osteophyte complex with uncovering of the disc and ligamentum flavum thickening, resulting in moderate central canal stenosis, moderate to severe right foraminal stenosis, and moderate left foraminal stenosis.C5-6: There is disc osteophyte complex, resulting in mild central canal stenosis and moderate left greater than right foraminal stenosis. There is uncovertebral joint hypertrophy at this level.C6-7: There is disc osteophyte complex resulting in moderate to severe right foraminal stenosis and moderate left foraminal stenosis. There is uncovertebral joint hypertrophy at this level. There is no evidence of significant central canal stenosis.C7-T1: There is disc osteophyte complex with uncovering of the disc. There is moderate bilateral foraminal stenosis and uncovertebral joint hypertrophy at this level.T1-T2: On sagittal images, there is a disc bulge with moderate right foraminal stenosis and mild left foraminal stenosis at this level.T2-T3 and T3-T4: On sagittal images, there is disc bulge and mild left foraminal stenosis at this level.MRI Soft Tissue Neck:The orbits are unremarkable. The paranasal sinuses and mastoid air cells are clear. The oral cavity, oro/nasopharynx, hypopharynx, larynx and subglottic airways are unremarkable/patent. The epiglottis, vallecula, piriform sinuses, and vocal cords are normal. The parotid, submandibular, and thyroid glands are unremarkable. No lymphadenopathy is noted. The carotid arteries and jugular veins are patent. The osseous structures are unremarkable.
1. Innumerable small hyperintense foci on FLAIR images, likely representing chronic small vessel ischemic disease, however other etiologies are not excluded.2. Irregularity of the left posterior globe, likely representing staphyloma. 3. Multilevel degenerative changes of the cervical spine, with up to moderate to severe foraminal stenosis and moderate central canal stenosis at the levels described above.4. MR neck is unremarkable.