Clinical question: Evaluate for pathology. Signs and symptoms: Bilateral clonus on exam. Nonenhanced cervical MRI:There is normal anatomical alignment of vertebral column. There is however straightening of cervical lordosis which could be positional or due to pain.Foramen magnum is unremarkable.C2-C3 demonstrate minimal degenerative changes with resultant mild left neural foraminal compromise.C3-C4 demonstrate mild degenerative changes with resultant moderate left and mild right neural foraminal compromise.C4-C5 demonstrate a right lateral disc protrusion with resultant effacement of ventral subarachnoid space however without central spinal stenosis or definitive detectable cord signal abnormality. There is moderate to significant bilateral (R>L)neural foraminal compromise.C5-C6 demonstrate mild degenerative changes without central spinal stenosis or definitive neural foraminal compromise.C6-C7 is unremarkable.C7-T1 is unremarkable.Partially visualized paraspinal soft tissues demonstrate enlarged right-sided lower neck pathologic nodes as was mentioned on prior chest CT. The largest node measures at 20 x 19 mm in transaxial dimensions.
1.Mild degenerative changes with resultant multilevel neural foraminal compromise however without evidence of central spinal stenosis. Please review detailed report per level above.2.Right lateral broad-based disc protrusion at C4-C5 without detectable cord signal abnormality or central spinal stenosis.3.No detectable osseous signal abnormality to suggest metastatic lesions.4.Pathologically enlarged right lower neck lymph nodes largest measuring 20 x 19 mm in transaxial dimensions.