 Brain: There is no restricted diffusion to suggest recent infarct. No intracranial mass or mass effect. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes and not appreciably changed since 4/8/2015. There is mild supra and infratentorial parenchymal volume loss. The ventricles and basal cisterns are normal in size and configuration for age. There is no midline shift or herniation. The skull and extracranial soft tissues are grossly unremarkable.Cervical spine: As seen on prior CT, there are postsurgical changes of cervical laminoplasty extending from C3 to C7 with laminectomies, spinous processes resection, and bone grafts at the C4 and C6 levels, with osseous incorporation of the grafts better seen on prior CT. Spinal canal at the operated levels remains decompressed and markedly improved since prior MRI from 6/11/2014. Cervical vertebral bodies are appropriate in height. Unchanged cervical alignment without kyphosis on these supine images. No suspicious bony lesions are identified in the cervical spine. Advanced degenerative changes with multilevel disc height loss, most severely affecting the C4-C5, C5-C6, and C6-C7 disc spaces, again seen. No cord signal abnormality is definitively appreciated.Additional details as below:C2-3: No significant compromise to the spinal canal. There is mild left greater than right neural foraminal narrowing related to facet arthropathy as seen on CTC3-4: There is mild narrowing of the spinal canal with effacement of the dorsal thecal sac related to ligamentum flavum thickening and small disc osteophyte complex anteriorly. There is moderate to severe right neural foraminal stenosis related to uncovertebral hypertrophy and facet arthropathy. Left neural foramen is patent. C4-5: There is disc osteophyte complex. Spinal canal remains decompressed. There is mild to moderate left and mild right neural foraminal narrowing related to uncovertebral hypertrophy and facet arthropathy.C5-6: No spinal canal stenosis. There is uncovertebral hypertrophy and facet arthropathy. There is mild to moderate right and mild left neural foraminal narrowing. C6-7: Prominent left paracentral disc osteophyte complex and uncovertebral hypertrophy. Spinal canal is decompressed aside from partial effacement of the left ventral thecal sac. There is moderate left and mild right neural foraminal narrowing. C7-T1: No significant compromise to the spinal canal. Mild to moderate bilateral neural foraminal narrowing.Paraspinous soft tissues are unremarkable aside from postsurgical changes. Multinodular goiter is again noted.
1. Mild chronic small vessel ischemic changes similar to prior from 4/8/2015. No acute infarct, intracranial mass, or mass effect.2. Postsurgical changes of cervical laminoplasty. Spinal canal is decompressed. There is relatively mild spinal canal narrowing at the C3-C4 and C6-C7 levels. No cord signal abnormality.3. Multilevel neural foraminal stenosis throughout the cervical spine as seen on recent CT from 5/19/2015 and detailed above.