Cervicalgia, post concussive syndrome. MVA one month ago, flashbacks since, memory loss, headaches, foggy brain. Brain: Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with chronic small vessel ischemic changes. No focal area of traumatic encephalomalacia. There is punctate focus of susceptibility effect involving the left occipital lobe compatible with chronic microhemorrhage and nonspecific. Brain parenchyma is otherwise unremarkable for age. There is mild global parenchymal volume loss which appears appropriate for age. No restricted diffusion to suggest acute ischemia. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. No abnormal parenchymal or meningeal enhancement. Major flow-voids are preserved. Paranasal sinuses and mastoid air cells are clear. Bone marrow signal is within normal limits. Cervical Spine:Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. There is mild loss of cervical lordosis and mild retrolisthesis of C4 on C5. Alignment is otherwise grossly maintained. Bone marrow signal is benign. The cervical spinal cord has normal signal characteristics and overall morphology. No evidence of cord edema, hemorrhage, or focal volume loss to suggest prior cord injury. Degenerative changes are seen in the cervical spine with disc osteophyte complexes at C3-C4, C4-C5, C5-C6. Individual levels as below:C2-3: No significant compromise to the spinal canal or neural foramina.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy on the right. No significant compromise to the spinal canal or neural foramina.C4-5: Small disc osteophyte complex and ligamentum flavum thickening. There is minimal spinal canal narrowing. There is mild to moderate right neural foraminal stenosis related to uncovertebral hypertrophy and no significant left neural foraminal stenosis. C5-6: Small small disc osteophyte complex and ligamentum flavum thickening with minimal spinal canal narrowing. There is mild to moderate right and moderate left neural foraminal stenosis.C6-7: Minimal disc bulge. No significant spinal canal or neural foraminal stenosis.C7-T1: No significant compromise to the spinal canal or neural foramina. Mild left-sided facet arthropathy.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. No evidence of traumatic encephalomalacia or definitive evidence of traumatic brain injury. No intracranial mass or mass effect. There is a punctate focus of chronic microhemorrhage in the left occipital lobe which is nonspecific and may be related to prior trauma, for example, but other etiologies like amyloid angiopathy should also be considered. Additional scattered foci of T2/FLAIR hyperintensity in the periventricular and subcortical white matter are also nonspecific but favored to be related to mild chronic small vessel ischemic disease. Brain MRI is otherwise unremarkable for age.2. No evidence of traumatic cord injury. There are degenerative changes in the cervical spine without significant spinal canal stenosis. There is mild to moderate right C4-C5 neural foraminal stenosis and mild to moderate right and moderate left C5-C6 neural foraminal stenosis. 