Clinical question: Ischemia. Signs and symptoms: Right-sided weakness. Nonenhanced brain MRI:Diffusion weighted images are negative for an acute ischemic stroke.There are tiny foci of periventricular and subcortical FLAIR hyperintensity only in the subcortical and periventricular white matter of cerebral hemispheres. Findings demonstrate tiny foci of internal susceptibility suggestive of microhemorrhages. Constellation of findings are believed to represent chronic small vessel ischemic strokes of mild degree. There is normal anatomical morphology and signal intensity of brain parenchyma otherwise on all MRI sequences area unremarkable cerebral cortex, cortical sulci, ventricular system otherwise and with maintained midline.The signal void of major intracranial arterial branches are identified.Images through the orbits demonstrate a prostheses on the right and unremarkable otherwise.On paranasal sinuses and bilateral mastoid air cells and middle ear cavities demonstrate normal pneumatization signal pattern.Nonenhanced cervical MRI:There is normal anatomical alignment of the vertebral column however with mild straightening of cervical lordosis.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes and unremarkable otherwise.C3-C4 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C4-C5 demonstrate mild degenerative changes and unremarkable otherwise.C5-C6 demonstrate a right paramedian disc protrusion with resultant flattening deformity and posterior displacement of the cord on the right and mild central spinal stenosis. No neural foraminal compromise and no detectable cord signal abnormality. (Finding is best appreciated on axial T2 series 1/7/2001 image 14 and sagittal T2/T2 STIR image 11).C6-C7 demonstrate a small shallow left-sided disc protrusion which results in subtle effacement of ventral subarachnoid space however without spinal stenosis or neural foraminal compromise.C7-T1 is unremarkable.Upper most visualized thoracic spine and thoracic cord is unremarkable.
1.Nonenhanced brain MRI demonstrate no acute ischemic process, chronic minimally hemorrhagic small vessel ischemic strokes of mild degree only in the subcortical and periventricular white matter, unremarkable intracranial contents otherwise, right eye prosthesis.2.Nonenhanced MRI of cervical spine demonstrate a focal disc protrusion on the right at C5-C6 with resultant mild central spinal stenosis and no neural foraminal compromise. Shallow left lateral disc protrusion at C6-C7 without spinal stenosis or neural foraminal compromise. Unremarkable images at other levels.