Reason: left eye ptosis, reduced visual field left eye, neck pain History: progressive bilateral upper extremity weakness MRI Brain: No intracranial mass or mass-effect. No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. The ventricles are within normal limits in size and configuration. Multiple patchy areas and scattered foci of T2/FLAIR hyperintensity are again seen in the bilateral subcortical and periventricular white matter as well as the pons, which are nonspecific, but most compatible with chronic small vessel ischemic disease. Brain parenchyma is otherwise unremarkable for age. No abnormal parenchymal or meningeal enhancement. Specifically no abnormal enhancement or masses are seen associated with the cranial nerves, cavernous sinuses, or skull base foramina. Major flow-voids are preserved.Outpouching of the posterior globes again seen which may suggest staphyloma. Small right maxillary mucous retention cysts and minimal paranasal sinus mucosal thickening again noted.MRI Soft Tissue Neck: Examination slightly motion degraded. No masses or abnormal enhancement is appreciated within the oral cavity, pharynx, or parapharyngeal soft tissues. Minimal asymmetric fullness noted at the left fossa of Rosenmuller without evidence of underlying mass. Scattered small cervical lymph nodes are seen which are nonspecific without significant lymphadenopathy.There are moderate degenerative changes in the cervical spine with up to moderate spinal canal and moderate to severe neural foraminal narrowing as described on recent MRI cervical spine study. Diffuse heterogeneity of the bone marrow signal is again seen which is nonspecific.
1. Moderate chronic small vessel ischemic disease. No evidence of intracranial mass or mass effect. No abnormal enhancement.2. No abnormal masses within the neck soft tissues are appreciated.3. Moderate degenerative changes in the cervical spine which may be contributing to patient's neck pain and better assessed on recent MRI cervical spine study.