78 years Male (DOB: 4/26/1937)Reason: eval for brain/spinal mets History: weaknessPROVIDER NAME: CARA A ROSENBAUM CARA A ROSENBAUM MRI brain:The CSF spaces are appropriate for the patient's stated age with no midline shift. There is a mild degree of periventricular and subcortical punctate hyperintense white matter lesions present identified on the FLAIR and T2 images.No abnormal enhancing mass lesions are appreciated intracranially. No intracranial hemorrhage is identified. No edema is identified within the brain parenchyma.Normal vascular flow voids are present in the distal carotid and vertebral arteries, the basilar artery and the proximal anterior, middle and posterior cerebral arteries as well as the internal cerebral veins and superior sagittal sinus.The pituitary infundibulum is mildly tilted, however, no underlying lesion is appreciated.The visualized portions of the paranasal sinuses are clear. The visualized portions of the mastoid air cells are clear. The visualized portions of the orbits are intact. The eyeball lenses are thin.MRI cervical spine:The cervical vertebral bodies are appropriate in overall alignment and height. The cervical spinal cord has normal signal characteristics and overall morphology. No abnormal enhancing lesions are identified in the cervical spine.There is fusion of the V3 and V4 vertebral bodies at the disk space. There is no significant change since the 9/25/2014 examAt C2-3 there is no significant compromise to the spinal canal or neural foramina. There is no significant change since the 9/25/2014 examAt C3-4 there is no significant compromise to the spinal canal. The fusion of the C3-4 disk space. There is encroachment of the left sided exiting nerve roots at this level due to osteophytes. There is no significant change since the 9/25/2014 examAt C4-5 there is no significant compromise to the spinal canal or neural foramina. There is loss of disk space height, disk dessication and posterior ligamentum flavum hypertrophy present at this level associated with effacement of the spinal fluid surrounding the spinal cord. There are endplate and uncovertebral osteophytes at this level. There is encroachment of the exiting nerve roots within the neural foramina at this level bilaterally. There is moderate spinal stenosis at this level. There is no significant change since the 9/25/2014 examAt C5-6 there is no significant compromise to the spinal canal. There is loss of disk space height, disk dessication and a mild disk bulge at this level. There is encroachment of the left sided exiting nerve roots at this level due to osteophytes and disk material. There is no significant change since the 9/25/2014 examAt C6-7 there is no significant compromise to the spinal canal or neural foramina. There is loss of disk space height, disk dessication and posterior ligamentum flavum hypertrophy present at this level . There are end plate reactive changes present at this level. There is mild spinal stenosis at this level. There is encroachment of the exiting nerve roots bilaterally at this level. There is no significant change since the 9/25/2014 examAt C7-T1 there is no significant compromise to the spinal canal. There is loss of disk space height, disk dessication and a mild disk bulge at this level. There is narrowing of the neural foramina bilaterally due to disk material and osteophytes with encroachment of the left sided exiting nerve roots at this level due to osteophytes and disk material. There is no significant change since the 9/25/2014 examThe vertebral artery flow voids appear to be intact.Thoracic spine:The thoracic vertebral bodies are appropriate in the overall alignment and height. The thoracic spinal cord has normal signal characteristics and overall morphology. There is no compromise of thoracic spinal canal or exiting nerve roots. No abnormal enhancing lesions are identified in the thoracic spine. Lumbar spine:Five lumbar type vertebral bodies are presumed to be present which are appropriate in overall alignment and height. The conus medullaris on sagittal imaging is grossly intact. No abnormal enhancing lesions are identified in the lumbar spine. There is no significant change since the 9/25/2014 exam.At L5-S1 there is no significant compromise to spinal canal or neural foramina. There is a mild disk bulge at this level.At L4-5 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, end plate reactive change, disk bulge and Schmorl's nodes at this level. There is patchy contrast enhancement present adjacent ot the endplates. At L3-4 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, end plate reactive change, disk bulge and Schmorl's nodes at this level. There is patchy contrast enhancement present adjacent ot the endplates. At L2-3 there is no significant compromise to spinal canal or neural foramina. There is loss of disk space height, end plate reactive change, disk bulge and Schmorl's nodes at this level. There is patchy contrast enhancement present adjacent ot the Schmorl's nodes.At L1-2 there is no significant compromise to spinal canal or neural foramina.
1.Periventricular and subcortical white matter lesions of a mild degree are nonspecific. At this age they are most likely vascular related. 2.There are degenerative changes in the cervical spine which are stable since the prior exam with moderate spinal stenosis at C4-5 and multilevel neural foramen encroachment as detailed above worse bilaterally at C4-5 and C6-7 and on the left side at C3-4, C5-6 and C7-1. There is no significant change since the 9/25/2014 exam.3.There are multilevel degenerative changes in the lumbar spine without significant compromise to the spinal canal or neural foramina but with inflammation due to subacute degenerative end plate reactive change at L2-3, L3-4 and L4-5. 4.No abnormal mass lesions are appreciated in the brain or the cervical, thoracic or lumbar spine.