Reason: r/o stenosis History: upper extremity weaknessAdditional history from EMR: Recent cerebral angiogram showed spinal epidural fistula on the right C8 root sleeve draining into the posterior perimedullary vein and eventually draining into bilateral epidural plexus. Postcontrast axial images are limited due to inhomogeneous fat suppression.There are no subluxations. There is straightening of cervical lordosis. Vertebral body heights are maintained. Discs are desiccated but disc heights are maintained. The marrow signal is benign. The cervical cord is normal in signal. The cervicomedullary junction is normal. Spinal cord has a smooth contour and is without focal atrophy, edema, myelomalacia. Prominent serpentine flow voids are seen posterior to the spinal cord within the thecal sac, most conspicuous from approximately C4 to C7 vertebral bodies although also visualized more cranially along the rest of the cervical spine with corresponding enhancement, corresponding to prior CTA neck findings, and again suggestive of dural arteriovenous fistula. There is no associated cord signal abnormality at any level.Redemonstration of recent right anterolateral cerebellar infarct with additional foci of other bilateral cerebellar and medullary T2 hyperintensity and susceptibility artifacts that are difficult to compare directly due to slice differences but grossly present. This includes the more recent right lateral cerebellar infarct, which is evolving. Fluid in the visualized left mastoid air cells, middle ear cavity, and paranasal sinuses. There is increased STIR signal in the musculature and subcutaneous tissue overlying the suboccipital region with mild enhancement of the deep soft tissues in this region.There are small foci of T2 hyperintensities in the right thyroid. Tracheostomy tube in place with fluid noted deep to the tip. Enlarged lymph node noted medial to the left inferior parotid gland and abutting the sternocleidomastoid muscle, which increased in size from prior CT, nonspecific but likely reactive.C1/2: No significant spinal canal stenosis or foraminal narrowing.C2/3: No significant spinal canal stenosis. Bilateral mild facet arthropathy with mild narrowing of the left foramina.C3/4: Mild posterior disc bulge with mild spinal canal stenosis. There is moderate bilateral foraminal narrowing.C4/5: Mild posterior disc bulge with mild spinal canal stenosis. There is moderate bilateral foraminal narrowing.C5/6: Mild posterior disc bulge with mild spinal canal stenosis. There is mild bilateral foraminal narrowing.C6/7: Mild to moderate posterior disc bulge with mild to moderate spinal canal stenosis. No significant foraminal narrowing.C7/T1: Partial fusion of the posterior elements and the vertebral bodies with diminutive disk, consistent with a segmentation anomaly. There is bilateral mild to moderate developmental foraminal narrowing.T1/T2: Hypertrophy of the ligamentum flavum with mild to moderate bilateral foraminal narrowing, seen on sagittal view only.
1.Multiple tiny serpentine flow voids seen predominantly posterior to the cervical cord, consistent with previously diagnosed dural AF fistula. This is better seen on prior angiogram. No associated cord signal abnormality.2.Multilevel degenerative disc disease of the C3/4-C5/6 levels and upper thoracic spine.3.Partial fusion of C7 and T1, consistent with segmentation anomaly, with developmental narrowing of foramina.4.Redemonstration of cerebellar and medullary ischemia and foci of chronic hemosiderin deposition. 