74-year-old female with right hemiparesis. Brain: There is no evidence of intracranial hemorrhage, mass or edema. There is a punctate focus of restricted diffusion in the left paramedian ventral pons, which likely represents an area of acute ischemia. Scattered periventricular and subcortical hypertense FLAIR signal abnormalities are compatible with chronic small vessel ischemic disease. Two subcentimeter foci of CSF signal intensity are seen in the right periventricular white matter, which likely represent old lacunar infarcts or prominent perivascular spaces. There is a wedge-shaped area of encephalomalacia in the right medulla, compatible with evolution of the prior infarction identified on the MRI dated 1/20/15. The ventricles and sulci appear prominent, compatible with parenchymal volume loss. No abnormal extra-axial fluid collection is identified. There is no midline shift or mass effect. The midline structures and craniocervical junction are within normal limits. Normal flow-voids are demonstrated in the major intracranial vascular structures. The paranasal sinuses are clear. There is partial opacification of the left mastoid sinus. There is a left lens replacement. The orbits are otherwise unremarkable. There is a non-specific right parotid gland nodule as seen on the recent CTA. Cervical Spine: The cervical spine demonstrates a normal alignment without evidence of subluxation or fracture. No significant marrow abnormalities are suspected. There is a focal, central disc protrusion at C2-C3 with mild narrowing of the central spinal canal. There is a focal, central disc protrusion at C3-4 with mild narrowing of central spinal canal and mild narrowing of the left neuroforamina. There is eccentric disc protrusion C4-5 with mild narrowing of the central spinal canal. At C5-6, there is mild disc bulge with mild narrowing of the right neuroforamina but no significant central spinal canal stenosis. At C6-7, there is mild disc bulge and mild bilateral neuroforaminal stenosis, left slightly greater than right, but no significant central spinal canal stenosis. There is no cord signal abnormality. There is an exophytic soft tissue nodule noted within the left neck, which is of uncertain clinical significance.
1.Punctate focus of restricted diffusion in the left paramedian ventral pons is compatible with acute ischemia. 2.Chronic infarct of the right medulla is seen.3.Cervical spondylosis is seen but no acute spinal abnormalities are detected.These findings were discussed with Dr. Kamson at the time of this dictation.