63-year-old male who presents with right leg spasticity for the past 2 months. Brain:There is supratentorial and infratentorial volume loss, which is greater than expected given the patient's age. There is also probably a component of hypoplasia involving the inferior cerebellar vermis. There are scattered areas of periventricular and subcortical white matter T2 hyperintensities which is compatible with moderate chronic small vessel ischemic disease. No evidence of acute infarct or hemorrhage. No abnormal extra-axial fluid collection is identified. There is no midline shift. Normal flow-voids are demonstrated in the major intracranial vascular structures. There are no areas of abnormal enhancement.The bilateral optic nerves and optic chiasm appear small. The paranasal sinuses are clear. The visualized mastoid air cells are clear. Cervical spine:The craniocervical junction is normal. There is normal cervical lordosis. The cervical spine alignment is anatomic. The vertebral body height is preserved. The bone marrow signal is benign. No abnormal signal within the cervical cord or volume loss is appreciated. No abnormal enhancement.There is congenital narrowing of the mid cervical spinal canal with superimposed degenerative changes. At C4-5, there is a disc osteophyte complex eccentric to the right with moderate right greater than left central spinal canal stenosis and mild bilateral neuroforaminal stenosis. At C5-6, there is minimal disc bulge and ligamentum flavum thickening with mild to moderate central spinal canal stenosis and mild-to-moderate bilateral neuroforaminal stenosis. There is otherwise no significant central spinal canal or neuroforaminal stenosis within the cervical spine. The paraspinal soft tissues are unremarkable.
1. Diffuse global supratentorial and infratentorial volume loss, which is greater than expected given the patient's age. There is also probable component of hyperplasia involving the inferior cerebellar vermis. 2. Multiple foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter which are nonspecific but compatible with moderate chronic small vessel ischemic changes. 3. No abnormal enhancement is seen within the brain or cervical cord to suggest an active inflammatory or active demyelinating process.4. Bilateral optic nerves and chiasm are small which may be related to prior injury but nonspecific.5. Degenerative changes in the cervical spine with up to moderate spinal canal stenosis at C4-C5 and C5-C6 as detailed above.