72 years, Male, dysphagia and dysarthria. Evaluate for brainstem stroke. Brain: No restricted diffusion to suggest acute ischemia. No intracranial hemorrhage. No intracranial mass or mass-effect. The ventricles are within normal limits in size and configuration. Several foci of T2/FLAIR hyperintensity are seen in the bilateral subcortical and periventricular white matter, which are nonspecific, but compatible with mild chronic small vessel ischemic changes. Brain parenchyma is otherwise unremarkable for age. Major flow-voids are preserved.Sella and orbits are grossly within normal limits. There is mild mucosal thickening involving the frontal, anterior ethmoid and maxillary sinuses. Bone marrow signal and extracranial soft tissues are within normal limits. Bilateral lens implants noted.Cervical spine: Craniovertebral junction appears within normal limits. The cervical vertebral bodies are appropriate in height. Alignment is maintained. The cervical spinal cord has normal signal characteristics and overall morphology. Bone marrow signal is benign with mild signal changes involving multiple endplates on a degenerative basis. There are multilevel degenerative changes with moderate disc height loss at the C5-C6 and C6-C7 levels and to a lesser degree C4-C5 level. Individual levels as described below:C2-3: No significant compromise to the spinal canal or neural foramina. There is prominent left-sided facet arthropathy.C3-4: Small disc osteophyte complex and uncovertebral hypertrophy on the right. There is mild right neural foraminal stenosis. There is mild spinal canal stenosis. No significant left neural foraminal narrowing.C4-5: Small disc osteophyte complex with left-sided uncovertebral hypertrophy as well as ligamentum flavum thickening. There is mild to moderate spinal canal stenosis with mild cord deformity. No cord signal abnormality. There is mild to moderate left neural foraminal stenosis. No significant right neural foraminal narrowing.C5-6: There is uncovertebral hypertrophy with mild to moderate right and mild left neural foraminal stenosis. No significant spinal canal stenosis.C6-7: No significant spinal canal stenosis. Mild to moderate neural foraminal stenosis bilaterally, right slightly worse in left, related to uncovertebral hypertrophy. C7-T1: No significant compromise to the spinal canal or neural foramina.The vertebral artery flow voids appear to be intact. Paraspinous soft tissue structures appear within normal limits.
1. Brain MRI appears within normal limits for age. Specifically, no evidence of infarct or intracranial mass.2. Degenerative changes in the cervical spine. There is mild to moderate spinal canal stenosis at C4-C5 and to a milder degree at C3-C4. No higher-grade spinal canal stenosis or cord signal abnormality.