History of rheumatoid arthritis, cervical cancer, now with new fecal incontinence and leg weakness. History of a cervical spine injury in 2015. Evaluate for metastasis, spinal cord compression, other etiology. MRI C-Spine:Redemonstration of cranial settling/basilar invagination with superior migration of the dens of up to 1 cm, which results in crowding at the foramen magnum and mild impression on the right medulla. Again seen is widening of the atlantodental interval up to 5 mm which appears less prominent compared to the previous exam due to patient positioning. There is subtle abnormal T2 signal suspected along the ventral aspect of the cervical cord but this also appears similar to the cervical spine MRI from 2008. The atlantooccipital joint is maintained. The cervical vertebral body heights are preserved. The bone marrow and end plates demonstrate a normal MR appearance without evidence of metastasis. The remainder of the cervical spine MRI demonstrates no significant spinal canal or neuroforaminal stenosis at any level. The paraspinal soft tissues are unremarkable. Heterogeneous appearance and fatty changes involving the bilateral parotid glands which may represent secondary Sjogren's. Right parotid gland cystic lesion is similar to prior.MRI L-Spine:Normal lordotic spinal alignment. There is edema involving the inferior aspect of the L5 vertebral body with subtle linear low T1 and T2 signal noted ventrally, findings which are suspected to represent an insufficiency fracture. No significant loss of height of the vertebral body is evident. There is no significant spinal canal or neuroforaminal stenosis at any level in the lumbar spine to suggest compression of the cauda equina. The conus medullaris terminates at the T12-L1 level. The paraspinal soft tissues are unremarkable.
1.Redemonstration of cranial settling/basilar invagination with superior migration of the dens resulting in crowding at the foramen magnum and mild impression on the right medulla. Subtle T2 hyperintensity is suspected in the ventral upper cervical cord. Remainder of the cervical spine MRI demonstrates no significant spinal canal or neural foraminal stenosis at any level.2.Edema involving the inferior aspect of the L5 vertebral body with subtle linear low T1 and T2 signal noted ventrally, findings which are suspected to represent an insufficiency fracture. No significant loss of height of the vertebral body is evident. There is no significant spinal canal or neural foraminal stenosis at any level in the lumbar spine to suggest compression of the cauda equina.3.Heterogeneous appearance and fatty changes involving the bilateral parotid glands which may represent secondary Sjogren's. Right parotid gland cystic lesion is similar to prior.