Clinical question: Encephalopathy. Signs and symptoms: AMS. Pre and post enhanced brain MRI:Diffusion weighted series demonstrate numerous tiny foci of restricted diffusion involving subcortical, periventricular, corpus callosal, bilateral basal ganglial (R>L), left occipital and left inferior cerebellum consistent with the scattered foci of acute stroke in the distribution of small vessels.Examination additionally demonstrate extensive periventricular and subcortical as well as bilateral basal ganglia, left thalamus and pontine foci of FLAIR and T2 hyperintensity consistent with extensive chronic small vessel ischemic strokes. Few of the chronic ischemic changes demonstrate susceptibility signal consistent with minimal hemorrhage.The cortical sulci, ventricular system and CSF spaces are within normal for patient of stated age and with maintained midline.Post contrast images demonstrate a single punctate focus of enhancement of a minimally hemorrhagic right basal ganglia acute stroke and unremarkable otherwise.Calvarium demonstrate normal signal intensity and without abnormal enhancement.Unremarkable images through the orbits and including axial fat sat postcontrast enhanced series. Bilateral mastoid air cells and middle ear cavities as well as all paranasal sinuses demonstrate normal pneumatization signal patterns. Note however is made of severe leftward deviation of nasal septum.Pre- and post enhanced cervical MRI:There is normal anatomical alignment of the vertebral column.There is normal signal intensity and caliber of cervical and upper most visualized thoracic cord.Foramen magnum is unremarkable.C2-C3 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C3-C4 demonstrate degenerative changes with asymmetric left facet and the left uncovertebral hypertrophy changes. Findings result seen significant left neural foraminal compromise and without compromise of the right neural foramina or spinal canal.C4-C5 demonstrate moderate disc disease and loss of disc height, mild bilateral (L>R) facet and ligamentum flavum hypertrophy. No spinal stenosis, patent left and moderate right neural foraminal compromise.C5-C6 demonstrate moderate disc disease and loss of disc height, moderate left and mild right facet hypertrophy and mild asymmetric left uncovertebral hypertrophy. Constellation of changes results in mild to moderate left neural foraminal compromise, patent right neural foraminal and no central spinal stenosis.C6-C7 demonstrate mild degenerative changes without spinal stenosis or neural foraminal compromise.C7-T1 is unremarkable.Postcontrast images demonstrate mild expected enhancement of degenerative changes in particular of the endplates at C4-C5 level and unremarkable otherwise.
1.Brain MRI demonstrate diffuse scattered tiny foci of cortical, subcortical, corpus callosal, bilateral basal ganglia, left occipital and left cerebellar restricted diffusion consistent with acute ischemic strokes. Extensive chronic small vessel ischemic strokes both in supra and infratentorial parenchyma is also noted with few demonstrating minimal internal hemorrhagic changes. There is no detectable abnormal enhancement. No appreciable mass effect or midline shift. Please see above comments.2.Cervical MRI demonstrate degenerative changes without evidence of central spinal stenosis. Multilevel neural foraminal compromise as detailed per level above. Normal signal intensity and caliber of cervical and upper most visualized thoracic cord. Postcontrast images demonstrate expected enhancement of degenerative changes and unremarkable otherwise.