32 years, Female, headache, left optic neuritis, history of mild Chiari, rheumatoid arthritis on immunosuppressants. Evaluate for inflammatory versus infectious etiology. Brain: There is no significant parenchymal signal abnormality. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Cerebellar tonsils are borderline low without clear evidence of Chiari I malformation. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved.Orbits appear grossly unremarkable although note evaluation for optic nerve signal abnormality can be better performed with dedicated MRI orbit sequences. There is a partially empty sella. There is small left maxillary sinus mucus retention cyst. Paranasal sinuses are otherwise grossly clear. Bone marrow signal and extracranial soft tissues are within normal limits. Cervical spine: No cord signal abnormality or abnormal enhancement in the cervical spine. The cervical spine is in normal alignment, with a normal cervical lordosis. The vertebral body heights are well-maintained. No worrisome focal marrow signal abnormality is appreciated. Mild degenerative changes are present throughout the cervical spine with multilevel disc desiccation and small disc bulges from C3-C4 to the C5-C6 levels, which along with ligamentum flavum thickening contribute to mild spinal canal and minimal left neural foraminal narrowing at the C5-C6 level. There is no high-grade spinal canal or neural foraminal stenosis at any level.
1. Brain MRI demonstrates no evidence of inflammation/infection or demyelinating disease.2. Note evaluation for optic nerve signal abnormality can be better performed with dedicated orbital sequences. There is however no orbital mass lesion.3. Partially empty sella which can be a normal variant or associated with intracranial hypertension in the appropriate clinical setting. 4. Cerebellar tonsils are borderline low without significant crowding at the foramen magnum or clear evidence of Chiari malformation.5. No cord signal abnormality in the cervical spine. There are mild multilevel degenerative changes, as described above, without high-grade spinal canal or neural foraminal stenosis at any level.