70 year-old female with history of weakness and sensory deficits. Evaluate for CIDP vs. ALS vs. MND. Cervical spine:The cranial-cervical junction is normal. There is straightening of the normal cervical lordosis. The cervical spine alignment is anatomic. Vertebral body heights are preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing or myelopathy. There is diffuse disc desiccation at all cervical levels. No abnormal enhancement is observed within the spinal cord.There is a dense atherosclerotic plaque at the carotid bifurcations bilaterally resulting in a 70-80% stenosis on the left and 50-60% on the right. The visualized portions of the distal internal carotid artery are unremarkable. Additionally, there is an abnormal appearance of the right internal jugular vein with a potential plaque resulting in significant luminal narrowing. The left internal jugular vein is not well visualized.Degenerative changes are specified by the intervertebral level as follows: C2-C3: There is a mild disc bulge. No significant neuroforaminal or spinal canal stenosis.C3-C4: There is a moderate disc bulge with anterior osteophyte formation. No significant neuroforaminal or spinal canal stenosis.C4-C5: There is a moderate disc bulge with anterior osteophyte formation. There is mild neuroforaminal narrowing on the left. No significant spinal canal stenosis.C5-C6: There is a mild disc bulge. No significant neuroforaminal or spinal canal stenosis.C6-C7: There is a mild disc bulge. No neuroforaminal narrowing or spinal stenosis. C7-T1: The disc is unremarkable. No neuroforaminal narrowing or spinal stenosis. Thoracic spine:There is a normal thoracic kyphosis. The spine alignment is anatomic. Vertebral body heights are preserved. The bone marrow and end plates demonstrate a normal MR appearance. The signal of the visualized cord is normal. The epidural space, thecal sac, and spinal cord are preserved with no evidence of spinal canal/neural foraminal narrowing, cord compression, or myelopathy. The conus medullaris terminates at the L1 level. The intervertebral discs demonstrate normal T2 intensity and height with no evidence of disc herniation. The paraspinal soft tissues are unremarkable. No abnormal enhancement is observed within the spinal cord.
1. The cervical and thoracic spinal cord appear normal with no evidence of ALS, CIDP, or MND as clinically queried.2. Dense atherosclerotic plaques at the carotid bifurcations bilaterally resulting in 70-80% stenosis on the left and 50-60% stenosis on the right. Additionally, the right internal jugular has an abnormal appearance with possible stenosis/plaque resulting in significant luminal narrowing. A CT angiogram with delayed phase is recommended for further evaluation.3. Degenerative arthritic changes of the cervical spine, worse at the C4-5 level, as described above.