Male, 54 years old, with spasticity. Assess for demyelinating disease. Brain:The cerebral and cerebellar hemispheres and brainstem show normal signal intensity and morphology. No restricted diffusion is seen. The right cerebellar tonsil extends slightly below the foramen magnum compatible with ectopia.No evidence of parenchymal edema, mass, or mass effect is seen. There is no evidence of intracranial hemorrhage or abnormal extra-axial fluid. The ventricular system is normal in caliber and morphology. The marrow signal characteristics are unremarkable. Mucosal thickening and/or mucus retention cysts are seen within the bilateral maxillary sinuses. Also noted is polypoid mucosal thickening within the posterior left nasal cavity. The right mastoid air cells show T2 hyperintense signal suggestive of fluid opacification.C spine:A long segment of T2 hyperintensity is seen affecting predominantly the right dorsal aspect of the spinal cord beginning at the C2-3 level and continuing down to at least to the C5-6 level. This abnormality is associated with no significant mass effect. No evidence of any blood product is seen.The cervical lordosis is mildly reversed. Vertebral body heights are preserved. No evidence of concerning marrow replacement or marrow edema is detected. Degenerative endplate signal alteration is seen at C5 and C6.C2-3: Left facet hypertrophy. No significant spinal canal or neuroforaminal stenosis. C3-4: Left facet hypertrophy. Right-sided uncovertebral hypertrophy. No significant spinal canal stenosis. Moderate left and mild right foraminal narrowing. C4-5: Left facet hypertrophy. Mild posterior disk osteophyte formation. Mild ventral thecal sac effacement without significant spinal canal stenosis. No significant foraminal narrowing. C5-6: Left greater than right facet hypertrophy. Posterior disk osteophyte formation asymmetric to the right subarticular zone. Mild effacement of the right ventral thecal sac, but no significant generalized canal stenosis. Mild right foraminal narrowing. C6-7: Left facet hypertrophy. Minimal posterior disk osteophyte formation. No significant generalized spinal canal stenosis. Mild left foraminal narrowing. C7-T1: No significant spinal canal or neuroforaminal stenosis.
A long segment of T2 signal abnormality is evident affecting predominantly the right dorsal aspect of the spinal cord. This abnormality extends from at least C2-3 to C5-6.The morphology of this lesion, and the lack of any lesions intracranially, would argue against classic multiple sclerosis. However, an atypical demyelinating process, such as neuromyelitis optica, could be considered. Other possibilities would include post-infectious autoimmune as well as non-infectious inflammatory conditions. Active infection is considered less likely but cannot be entirely eliminated.As above, evaluation of the brain is unremarkable with no additional findings to account for or help explain the patient's symptoms. Note is made of paranasal sinus mucosal thickening and a possible polyp in the left nasal cavity. Correlation with symptoms is suggested. 