Facial numbness. Eval for syrinx extension into the brainstem. MRI Brain:There is no evidence of intracranial hemorrhage, mass, or acute infarct. There are scattered T2 signal changes within the subcortical and periventricular white matter, likely related to chronic ischemic small vessel changes. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. There is a small right maxillary sinus retention cyst including scattered mucosal sinus disease. There is interval opacification of left mastoid air cells. The skull and extracranial soft tissues are unremarkable. MRI Cervical Spine:There are post surgical changes related to posterior decompression with a drainage catheter in the cord syrinx. There is reversal of the normal cervical lordosis and exaggerated kyphosis of the cervical spine centered around C7, unchanged from previous. The C7 vertebral body is densely sclerotic and demonstrates a severe compression deformity with retropulsion of the remainder of C7, that results in central canal stenosis at this level. However, no T2 STIR signal abnormality to suggest bone marrow edema. There is also anterior wedging of the left aspect of the T1 vertebral body without edematous changes.Redemonstrated is a large multiloculated syrinx which extends from C1 level. The lower aspect of the syrinx is obscured by motion artifact, however there does not appear to be significant change from previous with likely termination of the syrinx at the T3 level. There is significant thinning of the cord distally.There is multilevel disc dessication. There is complete loss of disc height and fusion of the C6 vertebral body and remaining portion of the C7 vertebral body. There is severe multilevel facet and uncovertebral hypertrophy that results in multilevel neural foraminal narrowing. At C5-C6, there is uncovertebral hypertrophy resulting in mild to moderate narrowing of the left neural foramen. At C6-C7, there is bilateral facet and uncovertebral hypertrophy with resulting moderate to severe narrowing of left neural foramen. At C7-T1, there is retropulsion of the C7 vertebra along with bilateral facet and uncovertebral hypertrophy resulting in severe left neural foraminal narrowing, where there is a bony spur and moderate right neural foraminal narrowing. These findings remain unchanged from previous exam.
1. No acute intracranial abnormality.2. Periventricular and subcortical white matter hyperintensities compatible with chronic small vessel ischemic disease.3. Very large multiloculated syrinx that extends from C1 to T3 with significant thinning of the cord distally, with associated postsurgical changes from posterior decompression, similar to prior exam.4. Chronic compression fractures of C7 and T1 and retropulsion of C7, unchanged.5. There is severe left neural foraminal narrowing and moderate right neural foraminal narrowing at C7-T1, similar to previous. Additional neural foraminal narrowing at multiple levels as detailed.