Male, 81 years old, with history of multiple myeloma and new onset headache for five days. MRI brain:No significant parenchymal signal abnormality is seen including no evidence of restricted diffusion. Brain parenchymal morphology is within normal limits. No acute intracranial hemorrhage or abnormal extra-axial fluid is seen. The pattern of parenchymal enhancement is within normal limits. The ventricular system is normal in size and morphology. No dural abnormalities are suspected. The calvarial marrow shows normal signal characteristics. Scattered polypoid areas of mucosal thickening are seen within the maxillary sinuses.MRI cervical spine:Trace anterolisthesis of C5 relative to C6 and C6 relative to C7 is noted. Mild degenerative wedging of the C5 and C6 vertebral bodies is seen without evidence of marrow edema. No areas of concerning marrow replacement or pathologic marrow enhancement are evident.Foci of spinal cord T2 hyperintensity are seen at the C3-4 level in association with disc osteophyte disease which impinges upon the spinal cord. The spinal cord is relatively thinned at this level. Elsewhere, no definite spinal cord signal abnormality is seen. No epidural abnormalities are suspected. No pathologic cord or leptomeningeal enhancement is seen.Severe disc degeneration is evident at most levels in the cervical spine. This is most severe at C5-6 and C6-7 where there is near complete loss of disc height. Additional level specific findings are as follows:C2-3: Right greater than left facet hypertrophy. Mild posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate bilateral foraminal narrowing. C3-4: Facet hypertrophy. Posterior disc-osteophyte complex formation with central focality which impinges on the spinal cord and causes a moderate generalized spinal canal narrowing. Severe left and moderate right foraminal narrowing. C4-5: Facet hypertrophy. Posterior disc-osteophyte complex formation which causes a circumferential moderate spinal canal stenosis. Moderate left and mild right foraminal narrowing. C5-6: Facet hypertrophy. Posterior disc-osteophyte complex formation which causes a circumferential mild to moderate spinal canal stenosis. The neural foramina are severely narrowed bilaterally. C6-7: Facet hypertrophy. Posterior disc-osteophyte complex formation. Mild generalized spinal canal stenosis. Moderate right and mild left foraminal narrowing. C7-T1: Facet hypertrophy. Posterior disc-osteophyte complex formation. No significant spinal canal stenosis. Moderate to severe left foraminal narrowing.
1.Unremarkable evaluation of the brain with no findings to account for the patient's headaches.2.Severe multilevel disc and posterior element degeneration is seen in the cervical spine. At C3-4, a disc osteophyte process impinges on the spinal cord and is associated with cord signal abnormality which is favored to represent myelomalacia. Spinal canal stenoses are also seen at C4-5 and C5-6. Scattered significant foraminal narrowing is also evident as above.