64-year-old female with chronic cervical radiculopathy. There is patchy T2 hyperintensity visualized within the pons.Focal T2/STIR hyperintensity is noted in the right paramedian dorsal location at the C1-C2 level. Punctate abnormal signal is suggested in the left side of the spinal cord at the upper C4 level. There is no associated volume loss at these levels to suggest myelomalacia. Further, there is no anatomic narrowing of the spinal canal at these levels.Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is trace grade 1 retrolisthesis of C5 on C6. There is diffuse disc desiccation. There is a small disc bulge at C5-C6 and resultant mild right as well as moderate left foraminal stenosis at this level. Bone marrow signal is within normal limits. The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. Focal areas of abnormal signal in the cord at the right paramedian dorsal C1-C2 level and left upper C4 level. Please correlate clinically for possible demyelinating disease, especially as patchy signal is also noted in the visualized pons although this could represent age-indeterminate small vessel ischemic changes. No definite volume loss to suggest myelomalacia. Differential would also include sequelae of previous ischemia or infection. Dedicated contrast enhanced brain MRI is recommended, and if clinically warranted a thoracic spine MRI could also be obtained.2. Trace retrolisthesis of C5 on C6 with a disc bulge at that level causing mild right and moderate left neural foraminal stenoses.