 MRI BRAIN:There are patchy areas of T2 FLAIR hyperintensities in the subcortical and the periventricular white matter and in the pons, which are nonspecific, but most consistent with chronic small vessel ischemic changes. There is a small chronic infarct involving the left precentral gyrus that was seen in the previous study of 5/12/2015. Ventricular size is normal. No midline shift. The basal cisterns are patent. No evidence for acute intracranial hemorrhage, mass effect, or edema.Incidentally noted small lipoma in the left periorbital scalp.MRI C-SPINE: Examination is moderately motion degraded. There is a minimal retrolisthesis/dorsal angulation at the C5-C6 level. There is significant loss of disc height at the C5-C6 level with endplate fatty marrow signal changes. Motion limits evaluation for cord signal abnormality, however no definite cord signal abnormality is appreciated.C2-C3: No evidence of spinal canal or foraminal compromise.C3-C4: No evidence of spinal canal or neural foraminal compromise.C4-C5: No spinal or neural foraminal compromise. C5-C6: There is disc osteophyte complex with effacement of the ventral thecal sac. There is uncovertebral hypertrophy with associated mild to moderate bilateral neural foraminal narrowing.C6-C7: There is no spinal or neural foraminal compromise.The visualized portion of the thoracic spine demonstrates disc bulge of the disc space T3-T4.C7-T1: There is no spinal canal foraminal compromise.MRA BRAIN:There study is motion degraded.There is a hypoplastic left A1 segment with fetal origin of the left PCA and nonvisualization of the left P1 segment. There is mild atherosclerotic narrowing involving the left cavernous and supraclinoid internal carotid arteries without evidence of high-grade stenosis in the anterior or posterior circulations. Patent bilateral posterior communicating arteries. The right vertebral artery is small beyond the PICA origin.
1. Brain MRI demonstrates no evidence of acute infarct, mass effect, or edema. Mild chronic small vessel ischemic changes and small left precentral gyrus infarct again seen.2. Evaluation of the cervical spine again demonstrates degenerative changes at the C5-C6 level with mild to moderate degree of spinal canal stenosis. Cord signal abnormality is not well evaluated given the motion degradation; however no definite cord signal abnormality is appreciated. There is mild to moderate bilateral neural foraminal stenosis at this level.3. MRA is slightly motion degraded. There is mild atherosclerotic narrowing of the left cavernous and supraclinoid internal carotid arteries. No high-grade stenosis in the intracranial anterior or posterior circulation.