Left arm weakness. Brain: There are punctate foci of restricted diffusion with corresponding high T2 signal at the grey-white matter interfaces of the right precentral and postcentral gyri, as well as the left inferior parietal lobule. There is a background of mild bilateral cerebral and pontine white matter T2 hyperintensity without corresponding restricted diffusion. There is no evidence of intracranial hemorrhage or mass. The ventricles and basal cisterns are normal in size and configuration. There is no midline shift or herniation. The major cerebral flow voids are intact. The orbits, skull, and scalp soft tissues are grossly unremarkable. There is scattered mild paranasal sinus mucosal thickening.Cervical Spine: There is a diffusely congenitally narrow spinal canal. At C2-3, there is bilateral uncovertebral hypertrophy with mild bilateral neural foraminal narrowing, but no spinal cord compression. At C3-C4, the vertebral bodies are fused, but there is no spinal cord compression or significant neural foraminal stenosis. At C4-5, there is bilateral uncovertebral and facet joint hypertrophy with moderate bilateral neural foraminal narrowing, but no spinal cord compression. At C5-6, there is a posterior disc-osteophyte eccentric to the right, which indents the spinal cord and bilateral uncovertebral hypertrophy, which narrows the bilateral neural foramina. At C6-7, there is an eccentric left posterior disc-osteophyte complex that abuts the left aspect of the spinal cord and markedly narrows the left neural foramen, while uncovertebral hypertrophy mildly narrows the right neural foramen. At C7-T1, there is no significant spinal canal or neural foraminal stenosis. Aside from endplate degenerative signal alterations at multiple levels, the vertebral bone marrow signal is unremarkable. There is no spondylolisthesis. The vertebral body heights are preserved. There is no abnormal spinal cord signal. The paravertebral soft tissues are unremarkable.
1. A few punctate recent infarcts in the bilateral cerebral hemisphere are likely embolic in nature and superimposed a background of what likely represent mild chronic small vessel ischemic white matter disease. Head and neck vascular imaging may be useful for further evaluation.2. A congenitally narrow spinal canal with superimposed degenerative spondylosis results in multilevel spinal canal and neural foramina stenosis, particularly at C4 though C7.Discussed with Dr. Solivan at 3:15 PM on 4/11/16.