Gait imbalance and brisk deep tendon reflexes. Brain MRI with and without Contrast:There are scattered, punctate T2/FLAIR hyperintense foci in the cerebral white matter, most numerous in the frontal and parietal white matter. They show no diffusion restriction or contrast enhancement. These are nonspecific but likely represent mild chronic small vessel ischemic changes. Postcontrast images are notable for developmental venous anomalies in the left occipital lobe and in the left cerebellar hemisphere. There is no abnormal parenchymal contrast enhancement, otherwise. There is no mass or midline shift. The CSF-containing spaces are mildly enlarged reflecting mild global volume loss. There is no susceptibility artifact to indicate intracranial hemorrhage. Major cranial vessels are patent.Mastoid air cells are clear. Mucosal thickening is moderate in the anterior ethmoid sinuses and mild to minimal in the other paranasal sinuses. The orbits are notable for bilateral cataract surgery.Cervical Spine MRI without Contrast:There is exaggeration of the cervical lordosis. The vertebral bodies are preserved in height. Marrow signal is mildly heterogeneous and benign. The intervertebral discs show loss of height and T2 signal at multiple levels, most pronounced at C5-C6 and C6-C7 levels. The spinal cord shows normal morphology and signal (down to the lower T5 vertebral level). Small right thyroid nodule. The imaged cervical soft tissues show no gross abnormality.Multilevel degenerative changes as described below:C2-C3: There is no spinal canal or foraminal stenosis.C3-C4: Small disc-osteophyte complex slightly eccentric to the left. There is no significant spinal canal or foraminal stenosis.C4-C5: Left uncovertebral proliferative change causes mild left foraminal narrowing. There is no spinal canal or right foraminal stenosis.C5-C6: Disc osteophyte complex is associated with left more than right uncovertebral proliferative change. This results in moderate left and mild right foraminal stenoses. Ligamentum flavum thickening. There is mild spinal canal stenosis.C6-C7: Disc osteophyte complex is minimal. Ligamentum flavum thickening. Mild spinal canal narrowing. Uncovertebral and facet proliferative change results in mild to moderate bilateral foraminal narrowing.C7-T1: There is no spinal canal or foraminal stenosis.
1.No evidence of intracranial mass or mass effect. No evidence of acute infarct or hemorrhage. Mild chronic small vessel ischemic changes.2.Mild degenerative changes in the cervical spine without high-grade spinal canal stenosis at any level. No cord signal abnormality. Individual levels as above including relatively mild spinal canal narrowing at C5-C6 and C6-C7.I personally reviewed the Images and/or procedure with the Resident/Fellow and agree with this report.