Clinical question: Demyelination? Signs and symptoms: Lower extremity weakness. Pre and post enhanced brain MRI:Unremarkable diffusion weighted series.Images through the posterior fossa demonstrate a tiny linear right median pontine foci of FLAIR hyperintensity similar to prior exam and unremarkable images otherwise.Images through the supratentorial space demonstrate stable few scattered foci of FLAIR and T2 hyperintensity in the periventricular and to a lesser degree subcortical white matter of cerebral hemispheres as was noted on prior study. These findings are nonspecific, nonhemorrhagic and demonstrate no abnormal enhancement. This is a similar observation is prior exam. Although nonspecific considering patient's stated age of 81 the above findings likely representing chronic changes of microvascular ischemic disease. Possibility of demyelinating disease is considered significantly less likely and cannot be entirely excluded.The cerebral cortex, cortical sulci, ventricular system and CSF spaces are unremarkable for stated age.Signal voids of major intracranial arterial branches are identified. No abnormal parenchymal, leptomeningeal, calvarial or retroperitoneal abnormal enhancement.Pre- and post enhanced cervical MRI:The signal intensity and caliber of the cervical and upper most visualized thoracic cord is within normal and without intravenous or abnormal enhancement.Foramen magnum is unremarkable.C2-C3 is unremarkable.C3-C4 demonstrate mild degenerative changes with resultant moderate right neural foraminal compromise.C4-C5 demonstrate mild degenerative changes and unremarkable otherwise.C5-C6 demonstrate moderate disc disease and loss of disc height, mild facet and ligamentum flavum hypertrophy with resultant significant right and moderate left neural foraminal compromise and mild central spinal stenosis.C6-C7 demonstrate moderate disc disease and loss of disc height, mild broad-based bulging disc, moderate bilateral ligamentum flavum hypertrophy and mild facet disease. Moderate to severe left and moderate right neural foraminal compromise and mild central spinal stenosis.C7-T1 demonstrate moderate disc disease and loss of disc height, mild bilateral facet (left greater than right) and ligamentum flavum hypertrophy. No spinal stenosis however mild left neural foraminal compromise is detected.
1.Pre and post enhanced brain MRI demonstrate no acute intracranial process and no evidence of any new findings since prior study. Stable scattered nonspecific FLAIR hyperintensity in the periventricular anterolisthesis in the subcortical cerebral hemispheres and punctate focus in the right paramedian pons remained identical to prior exam and without evidence of hemorrhagic change or enhancement. Findings are more suggestive of mild chronic nonhemorrhagic small vessel ischemic strokes.2.Pre and post enhanced MRI of cervical spine demonstrate normal signal intensity and caliber of the cervical and upper most visualized thoracic cord without abnormal enhancement. Multilevel degenerative changes with resultant mild central spinal stenosis at C5-C6 and C6-C7 levels as detailed. Multilevel neural foraminal compromise as detailed per level above.